Provider Demographics
NPI:1003949819
Name:HAMMONDS, NICOLE S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:HAMMONDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:S
Other - Last Name:BENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1015
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-1015
Mailing Address - Country:US
Mailing Address - Phone:919-884-9033
Mailing Address - Fax:888-242-6653
Practice Address - Street 1:602 E ACADEMY ST STE 205
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-884-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0044481041C0700X
FLSW88041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002958Medicaid
FL1538344049Medicaid
NC6002958Medicaid