Provider Demographics
NPI:1497480172
Name:FRIDLEY, NICHOLE SUSAN (MS)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:SUSAN
Last Name:FRIDLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 N STURMER ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-7403
Mailing Address - Country:US
Mailing Address - Phone:304-823-2800
Mailing Address - Fax:
Practice Address - Street 1:70 N STURMER ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-7403
Practice Address - Country:US
Practice Address - Phone:304-823-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV744101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health