Provider Demographics
NPI:1407511546
Name:BROWN, NICOLE H (LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:H
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 RIVER CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8346
Mailing Address - Country:US
Mailing Address - Phone:252-321-3665
Mailing Address - Fax:
Practice Address - Street 1:154 BEACON DR STE I
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-7996
Practice Address - Country:US
Practice Address - Phone:252-353-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21433101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)