Organization
CRYSTAL E.NICKERSON, LLC
Active
Other names
Choice Behavioral Health & Consultation Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CRYSTAL EYVETTE NICKERSON BA (DIRECTOR)
(336) 617-0764
Entity
Organization
Contact information
Practice address
2302 W MEADOWVIEW RD, SUITE 228, BOX 24, GREENSBORO, NC 27407-3721
(336) 617-0764
(336) 617-0964
Mailing address
2302 W MEADOWVIEW RD, SUITE 228, BOX 24, GREENSBORO, NC 27407-3721
(336) 617-0764
(336) 617-0964
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3418853
—
NC
05
—
8702219
—
NC
Enumeration date
01/05/2012
Last updated
01/05/2012
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