Provider Demographics
NPI:1174976344
Name:ROSS, TICOLA CALDWELL (PHD, MSW, LCSWA)
Entity type:Individual
Prefix:DR
First Name:TICOLA
Middle Name:CALDWELL
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHD, MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 GREYLOCK CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1977 J N PEASE PL STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4528
Practice Address - Country:US
Practice Address - Phone:980-313-3020
Practice Address - Fax:704-980-8023
Is Sole Proprietor?:No
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical