Provider Demographics
NPI:1184136897
Name:NICHOLSON, JAMES WELDON I (LCSWA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WELDON
Last Name:NICHOLSON
Suffix:I
Gender:M
Credentials:LCSWA
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:WELDON
Other - Last Name:NICHOLSON
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:LCSWA
Mailing Address - Street 1:90 CASTLEROCK DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-1379
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6885 CLIFFDALE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-2833
Practice Address - Country:US
Practice Address - Phone:910-339-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPO12057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional