Provider Demographics
NPI:1821317934
Name:BETTIS, NICOLE LEIGH (EDS, LMFT, RPT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LEIGH
Last Name:BETTIS
Suffix:
Gender:F
Credentials:EDS, LMFT, RPT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MCCLURE
Other - Last Name:MILANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDS, LMFTA
Mailing Address - Street 1:7308 CANAL DR
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-3007
Mailing Address - Country:US
Mailing Address - Phone:252-675-5550
Mailing Address - Fax:252-631-0717
Practice Address - Street 1:8201 EMERALD DR
Practice Address - Street 2:
Practice Address - City:EMERALD ISLE
Practice Address - State:NC
Practice Address - Zip Code:28594-2746
Practice Address - Country:US
Practice Address - Phone:252-675-5550
Practice Address - Fax:252-631-0717
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1397106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105322Medicaid