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NPI Code Detail

MEDICARE: NICOLA KAY MSW, LCSW-A

MEDICARE: NICOLA KAY MSW, LCSW-A
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social WorkerP015370NC

General Provider Information

NPI Number : 1124627963
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLA KAY MSW, LCSW-A
Provider Business Mailing Address
First Line : 3622 CENTRAL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5638
Country : US
Telephone Number : 704-910-5810
Fax Number :
Provider Business Practice Location Address
First Line : 3622 CENTRAL AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28205-5638
Country : US
Telephone Number : 704-910-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2020
Last Update Date : 10/22/2020

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