Individual
MISS CASEY MARIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4160 PIEDMONT PKWY, GREENSBORO, NC 27410-8174
(336) 645-6733
Mailing address
3204 IMMANUEL RD, GREENSBORO, NC 27407-3537
(336) 814-7399
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-270534
NC
Other
Enumeration date
05/15/2023
Last updated
08/21/2023
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