Provider Demographics
NPI:1548512346
Name:SILVER, NICKY MIQUEAL (MASTERS W EDUCATION)
Entity type:Individual
Prefix:MR
First Name:NICKY
Middle Name:MIQUEAL
Last Name:SILVER
Suffix:
Gender:M
Credentials:MASTERS W EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14495 HWY 301 N
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823
Mailing Address - Country:US
Mailing Address - Phone:252-578-3252
Mailing Address - Fax:
Practice Address - Street 1:14495 HWY 301 N
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823
Practice Address - Country:US
Practice Address - Phone:252-578-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98(00005)101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health