=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184829020
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN CURTIS NANCE PH.D, LPCS, NCC.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 08/26/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1801 E 5TH ST SUITE 210
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-287-4855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 728 E 9TH ST
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28202-3102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-287-4855
-----------------------------------------------------
Fax | 704-343-0458
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 5219
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------