Provider Demographics
NPI:1619907987
Name:NICOLOTTI, LINDA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MARIE
Last Name:NICOLOTTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910A BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3077
Mailing Address - Country:US
Mailing Address - Phone:336-748-9070
Mailing Address - Fax:336-773-0332
Practice Address - Street 1:2910A BRIARCLIFF RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3077
Practice Address - Country:US
Practice Address - Phone:336-748-9070
Practice Address - Fax:336-773-0332
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2948103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1736OtherPBH
NC0454TOtherBCBS, NC HEALTH CHOICE
NC6000415Medicaid
NC2183535OtherCIGNA
NC990438OtherCENTERPOINT