Raquel Renee Nicholson, LCAS-A

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LCAS-28336 Issued in NC

Practice address

Port Health Services
4300-110 Sapphire Court
Greenville, NC 27834

Phone

(252) 752-0483

NPI assigned

Sep 1, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1661990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661990400000",
    "number": "1124748835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 BOYDS RD",
            "city": "GRIMESLAND",
            "state": "NC",
            "postal_code": "278378930",
            "telephone_number": "252-939-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PORT HEALTH SERVICES",
            "address_2": "4300-110 SAPPHIRE COURT",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "27834",
            "telephone_number": "252-752-0483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "RAQUEL",
        "middle_name": "RENEE",
        "credential": "LCAS-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-01",
        "last_updated": "2022-09-01",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-28336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Britney Nichols
• Clay A. Nichols, M.D.
• Sharonda Trabeth Nicholson-Bradley, RN
• Charter L Nicholson
• Christie Nicholson, MS, RD, LDN, CR
• Nicole Deen Counseling, PLLC
• Alexandra Nicoletta, PHD
• Alexis Amedeo Nicolosi
• Drew Nielsen, MD
• Elizabeth Anne Nielsen, NNP

• Addiction (Substance Use Disorder) Counselor in Greenville, NC
• Providers in Greenville, NC by specialty
• Addiction (Substance Use Disorder) Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.