Provider Demographics
NPI:1245218395
Name:NESTOR, JANET G (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:G
Last Name:NESTOR
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 POLO RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3859
Mailing Address - Country:US
Mailing Address - Phone:336-794-2343
Mailing Address - Fax:336-631-5430
Practice Address - Street 1:1615 POLO RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3859
Practice Address - Country:US
Practice Address - Phone:336-794-2343
Practice Address - Fax:336-631-5430
Is Sole Proprietor?:No
Enumeration Date:2006-01-07
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC471078OtherVALUE OPTIONS
NC132M2OtherBLUE CROSS/BLUE SHIELD