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General NPI Number Information
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NPI Number | 1770813016
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Entity Type | Organization
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Legal Business Name | CRYSTAL E. NICKERSON
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Dates
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Enumeration Date | 01/08/2010
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Last Update Date | 08/01/2019
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Provider Practice Location Address
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Address Line | 2302 W. MEADOWVIEW ROAD SUITE 228
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City | GREENSBORO
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State | NC
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Zip | 27407-6012
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Country | US
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Telephone | 336-218-5176
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Fax | 336-854-0279
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Provider Business Mailing Address
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Address Line | 2302 W. MEADOWVIEW ROAD SUITE 228; BOX 24
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City | GREENSBORO
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State | NC
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Zip | 27407-6012
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Country | US
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Telephone | 336-218-5176
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Fax | 336-854-0279
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Authorized Official
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Title or Position | DIRECTOR
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Name | MRS. CRYSTAL E NICKERSON
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Credential |
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Telephone | 336-508-8190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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