Provider Demographics
NPI:1902334832
Name:WATLINGTON, NICOLE L (LPCA, NCC, MS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:WATLINGTON
Suffix:
Gender:F
Credentials:LPCA, NCC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 W FRIENDLY AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-6345
Mailing Address - Country:US
Mailing Address - Phone:336-340-6566
Mailing Address - Fax:
Practice Address - Street 1:403 PARKWAY STE G
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1653
Practice Address - Country:US
Practice Address - Phone:336-340-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11992101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor