Provider Demographics
NPI:1477653681
Name:ELLINGTON, NICOLE (LPC, LCAS)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:ELLINGTON
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:CHERBONNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:834 BRIDLEMINE DR
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-3721
Mailing Address - Country:US
Mailing Address - Phone:919-244-3121
Mailing Address - Fax:
Practice Address - Street 1:834 BRIDLEMINE DR
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-3721
Practice Address - Country:US
Practice Address - Phone:919-244-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC7011101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health