Provider Demographics
NPI:1205205143
Name:DLAMINI, PHOLILE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHOLILE
Middle Name:
Last Name:DLAMINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20311 CHARTWELL CENTER DR UNIT 196
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5282
Mailing Address - Country:US
Mailing Address - Phone:704-755-5558
Mailing Address - Fax:704-741-5250
Practice Address - Street 1:18121 W CATAWBA AVE STE 5
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-5641
Practice Address - Country:US
Practice Address - Phone:704-755-5558
Practice Address - Fax:704-741-5250
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4916103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20-4689281Medicaid