Provider Demographics
NPI:1093430712
Name:NICKEL, SAMANTHA JOAN (LCSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JOAN
Last Name:NICKEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 NEWBRIDGE PKWY UNIT 401
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-1487
Mailing Address - Country:US
Mailing Address - Phone:810-422-3055
Mailing Address - Fax:
Practice Address - Street 1:120 CHADWICK SQUARE CT STE C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3200
Practice Address - Country:US
Practice Address - Phone:828-697-4187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0154051041C0700X
FL203351041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical