Provider Demographics
NPI:1740358571
Name:NUNES, NATASHA M (LCMHCS)
Entity type:Individual
Prefix:MS
First Name:NATASHA
Middle Name:M
Last Name:NUNES
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 BOLICK RD
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-4219
Mailing Address - Country:US
Mailing Address - Phone:910-520-8902
Mailing Address - Fax:
Practice Address - Street 1:3205 RANDALL PKWY STE 119
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2567
Practice Address - Country:US
Practice Address - Phone:910-520-8902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YP2500X
NC4781101YP2500X
NC4781S101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142FCOtherBCBS PROVIDER NUMBER
40900OtherNBCC NUMBER
NC6103112Medicaid
NC142FCOtherBCBS PROVIDER NUMBER