Provider Demographics
NPI:1366232852
Name:NICHOLSON, EVA MUNN (LCMHCA)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:MUNN
Last Name:NICHOLSON
Suffix:
Gender:
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2805
Mailing Address - Country:US
Mailing Address - Phone:704-487-4000
Mailing Address - Fax:
Practice Address - Street 1:116 LEE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3839
Practice Address - Country:US
Practice Address - Phone:704-487-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21279101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health