Provider Demographics
NPI:1215028063
Name:CAPEL, NANCY L (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:CAPEL
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 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:704-874-0707
Practice Address - Street 1:1022 SHELTON AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-6826
Practice Address - Country:US
Practice Address - Phone:704-768-2080
Practice Address - Fax:704-768-2081
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0103431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
39062AOtherGROUP MEDICARE NUMBER
00618162OtherGROUP MEDICAID NUMBER
NYJ400005462Medicare PIN