Provider Demographics
NPI:1861697203
Name:NIKKI CRECY
Entity type:Organization
Organization Name:NIKKI CRECY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FACIITY DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:GIOVANNI
Authorized Official - Last Name:CREECY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-257-6406
Mailing Address - Street 1:5104 FLAT ROCK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311-1585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6350 HAWFIELD DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2021
Practice Address - Country:US
Practice Address - Phone:910-867-8995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL026814320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities