Provider Demographics
NPI:1508562174
Name:ARNOLD-MINKLEY, NICHOLE LEIGH (LCAS-A)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LEIGH
Last Name:ARNOLD-MINKLEY
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4079 OLD NC 75
Mailing Address - Street 2:
Mailing Address - City:STEM
Mailing Address - State:NC
Mailing Address - Zip Code:27581-9512
Mailing Address - Country:US
Mailing Address - Phone:919-885-6549
Mailing Address - Fax:919-885-6549
Practice Address - Street 1:4079 OLD NC 75
Practice Address - Street 2:
Practice Address - City:STEM
Practice Address - State:NC
Practice Address - Zip Code:27581-9512
Practice Address - Country:US
Practice Address - Phone:918-885-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28617101YA0400X
NCA19055101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)