Provider Demographics
NPI:1265634414
Name:LARRICK, NANCY E (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:E
Last Name:LARRICK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GUILFORD RD.
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-9764
Mailing Address - Country:US
Mailing Address - Phone:336-454-2255
Mailing Address - Fax:
Practice Address - Street 1:101 S. ELM ST.
Practice Address - Street 2:SUITE 325 COUNSELING CENTER OF GREENSBORO
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401
Practice Address - Country:US
Practice Address - Phone:336-274-2100
Practice Address - Fax:336-274-6366
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103080Medicaid