Provider Demographics
NPI:1447685508
Name:NICHOLS, WILBERT III (LPC)
Entity type:Individual
Prefix:
First Name:WILBERT
Middle Name:
Last Name:NICHOLS
Suffix:III
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87195
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-0000
Mailing Address - Country:US
Mailing Address - Phone:910-486-8989
Mailing Address - Fax:910-826-3695
Practice Address - Street 1:2905 BREEZEWOOD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5503
Practice Address - Country:US
Practice Address - Phone:910-486-8989
Practice Address - Fax:910-826-3695
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health