Provider Demographics
NPI:1306201389
Name:NICHOLS, MONICA A (MA)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:A
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5323 HIDDEN DOVE LN
Mailing Address - Street 2:#303
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3784
Mailing Address - Country:US
Mailing Address - Phone:919-710-8684
Mailing Address - Fax:
Practice Address - Street 1:130 IOWA LN
Practice Address - Street 2:SUITE 203
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4494
Practice Address - Country:US
Practice Address - Phone:919-710-8684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-17
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12093101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional