Provider Demographics
NPI:1225425499
Name:NICHOLS, ELIZABETH MCINTOSH (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MCINTOSH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 YARMOUTH LANE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-7876
Mailing Address - Country:US
Mailing Address - Phone:864-219-0632
Mailing Address - Fax:
Practice Address - Street 1:609 S NEW HOPE RD STE 200C
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-4870
Practice Address - Country:US
Practice Address - Phone:704-208-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11512101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health