MEDICARE: NESBITT COUNSELING & CLINICAL SERVICES, INC.

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
1	101YP2500X	Professional Counselor	5164	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407895808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NESBITT COUNSELING & CLINICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	2021 HERON PT
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9341
Country	:	US
Telephone Number	:	336-398-4473
Fax Number	:

Provider Business Practice Location Address
First Line	:	2021 HERON PT
Second Line	:
City	:	WHITSETT
State	:	NC
Zip	:	27377-9341
Country	:	US
Telephone Number	:	336-398-4473
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/PRESIDENT
Name	:	MS. ZAKIA A NESBITT
Credential	:	MS, NCC, LPC
Telephone Number	:	336-398-4473

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	05/21/2012

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