# SOUTHERN MENTALITY PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215617709
- **Authorized official:** MRS. NICOLE JANE THOMPSON PMHNP (CEO, OWNER, NURSE PRACTITIONER)
- **Authorized official phone:** (603) 505-2922

## Contact information

- **Practice address:** 1914 J N PEASE PL, CHARLOTTE, NC 28262-4504
- **Practice address phone:** (704) 754-8718
- **Practice address fax:** (704) 803-5923
- **Mailing address:** 1914 J N PEASE PL, CHARLOTTE, NC 28262-4504
- **Mailing address phone:** (704) 754-8718
- **Mailing address fax:** (704) 803-5923

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 07/20/2023
- **Last updated:** 01/07/2025