Provider Demographics
NPI:1275615866
Name:NICOTRA, TERRY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:M
Last Name:NICOTRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 PROVIDENCE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2206
Mailing Address - Country:US
Mailing Address - Phone:919-360-0254
Mailing Address - Fax:919-286-1121
Practice Address - Street 1:180 PROVIDENCE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2206
Practice Address - Country:US
Practice Address - Phone:919-360-0254
Practice Address - Fax:919-286-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17570103TC0700X
NC3352103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical