Provider Demographics
NPI:1750794772
Name:STONE, NICOLE (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 LIGON MILL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4576
Mailing Address - Country:US
Mailing Address - Phone:919-397-5626
Mailing Address - Fax:
Practice Address - Street 1:203 CAPCOM AVE
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-6514
Practice Address - Country:US
Practice Address - Phone:919-397-5626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9094A106H00000X
NC1723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist