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General NPI Number Information
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NPI Number | 1265991731
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Entity Type | Organization
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Legal Business Name | NICOLE WARDELL, LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 3 CLEVELAND CT
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City | GREENVILLE
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State | SC
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Zip | 29607-2414
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Country | US
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Telephone | 864-901-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 63 E CASTLE DR
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City | GREENVILLE
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State | SC
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Zip | 29605-3204
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Country | US
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Telephone | 864-901-4600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE WARDELL
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Credential | LPC
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Telephone | 864-901-4600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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