Basic Information
| Provider Information | |||||||||
| NPI: | 1447685508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | WILBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 87195 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283040000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104868989 | ||||||||
| FaxNumber: | 9108263695 | ||||||||
| Practice Location | |||||||||
| Address1: | 2905 BREEZEWOOD AVE | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283035503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104868989 | ||||||||
| FaxNumber: | 9108263695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2013 | ||||||||
| LastUpdateDate: | 02/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 9670 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.