Healthcare Provider Details

I. General information

NPI: 1730084724
Provider Name (Legal Business Name): NICOLLETTE CUSHINOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 STILLWELL RD
WILMINGTON NC
28412-7630
US

IV. Provider business mailing address

4704 STILLWELL RD
WILMINGTON NC
28412-7630
US

V. Phone/Fax

Practice location:
  • Phone: 315-884-0422
  • Fax:
Mailing address:
  • Phone: 315-884-0422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP024476
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: