Provider Demographics
NPI:1184459158
Name:SARGENT, NICOLE (LCSWA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 COZY CREST DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-4866
Mailing Address - Country:US
Mailing Address - Phone:307-286-3296
Mailing Address - Fax:
Practice Address - Street 1:7621 PURFOY RD STE 201
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-6985
Practice Address - Country:US
Practice Address - Phone:919-355-9792
Practice Address - Fax:919-551-7518
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-07
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0203291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty