Provider Demographics
NPI:1952903890
Name:PRAH-ENNIN, NICOLE GABRIELLE (MSW, LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:GABRIELLE
Last Name:PRAH-ENNIN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 LONG ARROW DR
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-0049
Mailing Address - Country:US
Mailing Address - Phone:336-577-2104
Mailing Address - Fax:
Practice Address - Street 1:4032 LONG ARROW DR
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-0049
Practice Address - Country:US
Practice Address - Phone:336-577-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0153011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical