Provider Demographics
NPI:1942288741
Name:SEGAL, NINA JOYCE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:JOYCE
Last Name:SEGAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:NINA
Other - Middle Name:JOYCE
Other - Last Name:SIMKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5300 SIX FORKS ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4465
Mailing Address - Country:US
Mailing Address - Phone:919-785-0040
Mailing Address - Fax:919-783-7029
Practice Address - Street 1:5300 SIX FORKS ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4465
Practice Address - Country:US
Practice Address - Phone:919-785-0040
Practice Address - Fax:919-783-7029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0032161041C0700X
OHI18611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1149YOtherBCBS
NC1149YOtherBCBS