Provider Demographics
NPI:1811692189
Name:NEVINS, NOELLE ANN (LPC)
Entity type:Individual
Prefix:
First Name:NOELLE
Middle Name:ANN
Last Name:NEVINS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 BRINKLEY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-8336
Mailing Address - Country:US
Mailing Address - Phone:203-512-8840
Mailing Address - Fax:
Practice Address - Street 1:2375 BRINKLEY RD
Practice Address - Street 2:
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-8336
Practice Address - Country:US
Practice Address - Phone:203-512-8840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.006251101YM0800X
CT46.004519101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health