Provider Demographics
NPI:1679963805
Name:BODWELL, BRITTANY NICHOLE (LCMHC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICHOLE
Last Name:BODWELL
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 S CHERRY ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-5271
Mailing Address - Country:US
Mailing Address - Phone:336-892-9061
Mailing Address - Fax:336-899-0170
Practice Address - Street 1:138 S CHERRY ST STE 400
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-5271
Practice Address - Country:US
Practice Address - Phone:336-892-9061
Practice Address - Fax:336-899-0170
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional