Provider Demographics
NPI:1619230786
Name:VENTOUR, NICOLE (LCSW, LISW-CP/S)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:VENTOUR
Suffix:
Gender:F
Credentials:LCSW, LISW-CP/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W BARR ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-1950
Mailing Address - Country:US
Mailing Address - Phone:917-379-4989
Mailing Address - Fax:
Practice Address - Street 1:502 W MEETING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2324
Practice Address - Country:US
Practice Address - Phone:803-639-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0080931041C0700X
SC94461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1095Medicaid