Provider Demographics
NPI:1336892165
Name:BURLEY, NICOLE ISABELLA (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ISABELLA
Last Name:BURLEY
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-6062
Mailing Address - Country:US
Mailing Address - Phone:910-407-9473
Mailing Address - Fax:910-312-3632
Practice Address - Street 1:2460 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6062
Practice Address - Country:US
Practice Address - Phone:910-407-9473
Practice Address - Fax:910-312-3632
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC18678101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)