Individual
RAQUEL RENEE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCAS-A
Contact information
Practice address
PORT HEALTH SERVICES, 4300-110 SAPPHIRE COURT, GREENVILLE, NC 27834
(252) 752-0483
Mailing address
4641 BOYDS RD, GRIMESLAND, NC 27837-8930
(252) 939-0476
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS-28336
NC
Other
Enumeration date
09/01/2022
Last updated
09/01/2022
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