Healthcare Provider Details

I. General information

NPI: 1093430712
Provider Name (Legal Business Name): SAMANTHA JOAN NICKEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHADWICK SQUARE CT STE C
HENDERSONVILLE NC
28739-3200
US

IV. Provider business mailing address

21 NEWBRIDGE PKWY UNIT 401
ASHEVILLE NC
28804-1487
US

V. Phone/Fax

Practice location:
  • Phone: 828-697-4187
  • Fax:
Mailing address:
  • Phone: 810-422-3055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC015405
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number20335
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: