Provider Demographics
NPI:1902668320
Name:NICHOLS, ERICA PAIGE (LCAS-A)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:PAIGE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 LAROQUE AVE
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28555-9011
Mailing Address - Country:US
Mailing Address - Phone:910-650-3222
Mailing Address - Fax:
Practice Address - Street 1:1150 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8022
Practice Address - Country:US
Practice Address - Phone:252-764-9023
Practice Address - Fax:252-764-9054
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-28238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)