Provider Demographics
NPI:1184162638
Name:NEWTON, NICHELL
Entity type:Individual
Prefix:
First Name:NICHELL
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15105D JOHN J DELANEY DR # 247
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2741
Mailing Address - Country:US
Mailing Address - Phone:980-477-0334
Mailing Address - Fax:
Practice Address - Street 1:1675 CALLAHAN RD
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7608
Practice Address - Country:US
Practice Address - Phone:980-477-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-05
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8193101YP2500X
NC10586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional