Provider Demographics
NPI:1710922257
Name:ROY, NIVEDITA (LCAS, LCMHC)
Entity Type:Individual
Prefix:
First Name:NIVEDITA
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:LCAS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 SWEETEN CREEK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2716
Mailing Address - Country:US
Mailing Address - Phone:828-215-7865
Mailing Address - Fax:828-417-3761
Practice Address - Street 1:3653 SWEETEN CREEK RD STE 3
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2716
Practice Address - Country:US
Practice Address - Phone:828-215-7865
Practice Address - Fax:828-417-3761
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4279101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1407POtherBCBSNC GRP # 015HF
NC6103041Medicaid