Active NPI
Nicole King, LCSW
- Clinical Social Worker
- Wake Forest, NC
National Provider Identifier
1700411931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- C019782
- Practice address
- 3664 Genesis LN
Wake Forest, NC 27587-6088 - Phone
- (443) 538-7275
- NPI assigned
- Mar 9, 2020
- Last updated
- Apr 22, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | C019782 | NC | Primary |
Addresses
Primary practice location
3664 Genesis LN
Wake Forest, NC 27587-6088
Mailing address
3664 Genesis LN
Wake Forest, NC 27587-6088
Phone (443) 538-7275
Other practice location 1
103 Market St
Louisburg, NC 27549-2523
Phone (919) 443-5697
Other names 1
- Nicole Tai
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C019782 | NC | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mind & Mane PLLC | Clinical | Current | Accepting new patients |
| Mind & Mane LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Wake Forest, NC
- NPI 1578298774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1583712000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1700411931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3664 GENESIS LN",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275876088",
"telephone_number": "443-538-7275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3664 GENESIS LN",
"city": "WAKE FOREST",
"state": "NC",
"postal_code": "275876088",
"telephone_number": "443-538-7275"
}
],
"practiceLocations": [
{
"address_1": "103 Market St",
"address_purpose": "LOCATION",
"city": "Louisburg",
"state": "NC",
"postal_code": "275492523",
"country_code": "US",
"telephone_number": "919-443-5697",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KING",
"first_name": "NICOLE",
"name_prefix": "Dr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-03-09",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NC",
"license": "C019782",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "NICOLE",
"last_name": "TAI",
"credential": "LCSWA",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Wake Forest, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.