Provider Demographics
NPI:1942046438
Name:CARDWELL, KHAMIK
Entity type:Individual
Prefix:
First Name:KHAMIK
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BILLINGSLEY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:803-387-1503
Mailing Address - Fax:
Practice Address - Street 1:500 BILLINGSLEY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211
Practice Address - Country:US
Practice Address - Phone:803-387-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2025-01-08
Deactivation Date:2024-11-29
Deactivation Code:
Reactivation Date:2025-01-08
Provider Licenses
StateLicense IDTaxonomies
NCP0207151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical