Provider Demographics
NPI:1265586010
Name:NICHOLS, KRISTIN REINERS (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:REINERS
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:E
Other - Last Name:REINERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:PO BOX 26121
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27114
Mailing Address - Country:US
Mailing Address - Phone:336-745-9719
Mailing Address - Fax:
Practice Address - Street 1:3504 VEST MILL ROAD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-745-9719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7927101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7835797OtherAETNA
MD64750003OtherBCBS MD
MD82124600OtherMAGELLAN
DC50630001OtherBCBS DC