Provider Demographics
NPI:1225080757
Name:MOSTELLER-BOOTH, NICOLE A (LPC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:MOSTELLER-BOOTH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3449
Mailing Address - Country:US
Mailing Address - Phone:828-433-9190
Mailing Address - Fax:828-433-9130
Practice Address - Street 1:205 E UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3449
Practice Address - Country:US
Practice Address - Phone:828-433-9190
Practice Address - Fax:828-433-9130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102015Medicaid