Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 4449 | NC |
NPI | 1003868563 |
---|---|
Provider Name | Mrs. Shirley Nicholson |
First Address | Hendersonville, NC 28793-2649 |
Second Address | Hendersonville, NC 28792-4543 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6108396 | (05) | NC |