Provider Demographics
NPI:1316547995
Name:MORTON, NICOLE KRISTINE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINE
Last Name:MORTON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SANDY FORD RD
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9470
Mailing Address - Country:US
Mailing Address - Phone:262-573-8886
Mailing Address - Fax:
Practice Address - Street 1:133 ARBRIDGE CT
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-2457
Practice Address - Country:US
Practice Address - Phone:262-573-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health