# NICOLE ST. CLAIR SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Amanda's Place
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336272723
- **Authorized official:** MRS. KAREN MALLORY (CEO)
- **Authorized official phone:** (252) 578-9071

## Contact information

- **Practice address:** 4894 HIGHWAY 158, ROANOKE RAPIDS, NC 27870
- **Practice address phone:** (252) 535-1192
- **Mailing address:** 4894 HIGHWAY 158, ROANOKE RAPIDS, NC 27870
- **Mailing address phone:** (252) 535-1192

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | MHL042039 | NC | Yes |

## Other

- **Enumeration date:** 03/14/2007
- **Last updated:** 08/22/2020