Provider Demographics
NPI:1902200389
Name:SURETHING, NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SURETHING
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 1:3997 CEDARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8007
Mailing Address - Country:US
Mailing Address - Phone:540-693-0398
Mailing Address - Fax:
Practice Address - Street 1:1158 PROFESSIONAL DR STE N
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6618
Practice Address - Country:US
Practice Address - Phone:540-693-0398
Practice Address - Fax:844-386-6313
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004081103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist