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General NPI Number Information
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NPI Number | 1306568480
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Entity Type | Individual
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Provider Name | CHARLES NOLES LCMHCA, NCC
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Gender | Male
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Dates
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Enumeration Date | 09/14/2022
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 420 DURHAM STATION DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546-3400
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Country | US
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Telephone | 269-519-8726
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Fax |
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Provider Business Mailing Address
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Address Line | 521 YOPP RD # 214439
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City | JACKSONVILLE
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State | NC
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Zip | 28540-3595
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Country | US
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Telephone | 910-939-8461
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | NC
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