Provider Demographics
NPI:1104202266
Name:NICHOLS, GRACE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3761 NW CARY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-8438
Mailing Address - Country:US
Mailing Address - Phone:919-267-6747
Mailing Address - Fax:
Practice Address - Street 1:3761 NW CARY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8438
Practice Address - Country:US
Practice Address - Phone:919-267-6747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral