Healthcare Provider Details

I. General information

NPI: 1184162638
Provider Name (Legal Business Name): NICHELL NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2017
Last Update Date: 03/11/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 CALLAHAN RD
FORT MILL SC
29715-7608
US

IV. Provider business mailing address

15105D JOHN J DELANEY DR # 247
CHARLOTTE NC
28277-2741
US

V. Phone/Fax

Practice location:
  • Phone: 980-477-0334
  • Fax:
Mailing address:
  • Phone: 980-477-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10586
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: