Provider Demographics
NPI:1881405991
Name:NICHOLE PERALTA AZOR, PLLC
Entity type:Organization
Organization Name:NICHOLE PERALTA AZOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMHP, LPC, LADC
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA AZOR
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LPC, LADC
Authorized Official - Phone:308-249-7853
Mailing Address - Street 1:206 BEAVER CREEK ESTATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-9383
Mailing Address - Country:US
Mailing Address - Phone:308-249-7853
Mailing Address - Fax:531-248-4687
Practice Address - Street 1:750 BEAVER CREEK SCHOOL RD
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-7118
Practice Address - Country:US
Practice Address - Phone:308-249-7853
Practice Address - Fax:531-248-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty