Provider Demographics
NPI:1205025400
Name:VALENTINE, NICHOLE N (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:N
Last Name:VALENTINE
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 1:2153 BARROWCLIFFE DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3324
Mailing Address - Country:US
Mailing Address - Phone:843-367-8939
Mailing Address - Fax:
Practice Address - Street 1:2153 BARROWCLIFFE DR NW
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-3324
Practice Address - Country:US
Practice Address - Phone:843-367-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0121431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical