Provider Demographics
NPI:1336815042
Name:LENTZ, NICHOLE CAMPBELL (LCMHCA)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:CAMPBELL
Last Name:LENTZ
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 TREEBARK RD
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-5027
Mailing Address - Country:US
Mailing Address - Phone:704-902-4362
Mailing Address - Fax:
Practice Address - Street 1:413 LENTZ RD.
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3520
Practice Address - Country:US
Practice Address - Phone:704-902-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-22
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1190900101YS0200X
NCA16602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool