Provider Demographics
NPI:1033773064
Name:CATES, NICOLE (LPA, LCAS-A)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CATES
Suffix:
Gender:F
Credentials:LPA, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6211 PITCHKETTLE RD APT 306
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-4069
Mailing Address - Country:US
Mailing Address - Phone:336-269-0668
Mailing Address - Fax:
Practice Address - Street 1:3725 NATIONAL DR STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-4879
Practice Address - Country:US
Practice Address - Phone:919-781-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPA-5474103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical