Provider Demographics
NPI:1629896675
Name:GOLSTON, NICOLE (MA, CSAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GOLSTON
Suffix:
Gender:U
Credentials:MA, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FERRY POINT RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5236
Mailing Address - Country:US
Mailing Address - Phone:703-400-3886
Mailing Address - Fax:
Practice Address - Street 1:115 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1711
Practice Address - Country:US
Practice Address - Phone:757-562-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102861101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)