Provider Demographics
NPI:1881980100
Name:WHITED, NICOLAS ALLEN (LPC, CRC, CSAC, PBSF)
Entity type:Individual
Prefix:
First Name:NICOLAS
Middle Name:ALLEN
Last Name:WHITED
Suffix:
Gender:M
Credentials:LPC, CRC, CSAC, PBSF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SHORT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-4278
Mailing Address - Country:US
Mailing Address - Phone:276-963-1028
Mailing Address - Fax:
Practice Address - Street 1:113 SHORT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4278
Practice Address - Country:US
Practice Address - Phone:276-963-1028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102224101YA0400X
VA0701005169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)