Provider Demographics
NPI:1417835745
Name:NICHOLS, QURENA NICHELLE (LCSWA)
Entity type:Individual
Prefix:
First Name:QURENA
Middle Name:NICHELLE
Last Name:NICHOLS
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 1:82 GREEN CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-9247
Mailing Address - Country:US
Mailing Address - Phone:770-789-5644
Mailing Address - Fax:
Practice Address - Street 1:5617 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311-1423
Practice Address - Country:US
Practice Address - Phone:910-483-7377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
NCPO228191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker