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General NPI Number Information
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NPI Number | 1508964966
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Entity Type | Individual
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Provider Name | CELESTE H. NETTLES MBS, MS, LPC
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 445 DOLLEY MADISON RD STE B
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City | GREENSBORO
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State | NC
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Zip | 27410-5166
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Country | US
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Telephone | 336-500-9983
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Fax |
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Provider Business Mailing Address
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Address Line | 5315 BENNINGTON DR
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City | GREENSBORO
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State | NC
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Zip | 27410-3418
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Country | US
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Telephone | 336-500-9983
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5059
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License Number State | NC
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