Provider Demographics
NPI:1457833493
Name:POPE, JOHN-NELSON B (LPCS)
Entity Type:Individual
Prefix:DR
First Name:JOHN-NELSON
Middle Name:B
Last Name:POPE
Suffix:
Gender:M
Credentials:LPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 SPRUCE ST STE 315
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3386
Mailing Address - Country:US
Mailing Address - Phone:704-461-8253
Mailing Address - Fax:704-461-8267
Practice Address - Street 1:1212 SPRUCE ST STE 315
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3386
Practice Address - Country:US
Practice Address - Phone:704-461-8253
Practice Address - Fax:704-461-8267
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS13249101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376866079Medicaid