MEDICARE: NICOLE DONALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	A17840	NC

General Provider Information

NPI Number	:	1013645936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE DONALD

Provider Business Mailing Address
First Line	:	469 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	469 SHADY GROVE CT
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-5540
Country	:	US
Telephone Number	:	980-268-2745
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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Directions to “ NICOLE DONALD ” Practice Location

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