Crystal E. Nickerson

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

CRYSTAL E. NICKERSON

Practice address

2302 W. Meadowview Road Suite 228
Greensboro, NC 27407-6012

Phone

(336) 218-5176

Fax

(336) 854-0279

NPI assigned

Jan 8, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Crystal E Nickerson

Title

Director

Phone

(336) 508-8190

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Choice Behavioral Health & Consultation Services Doing business as

Electronic endpoints 1

Tax ID family

Choice Behavioral Health Consultation Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Crystal E.Nickerson, LLC

  • Respite Care
  • Greensboro, NC
  • NPI 1932479045
  NPD tax ID

Locations

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

{
    "created_epoch": "1262908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564617600000",
    "number": "1770813016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 W. MEADOWVIEW ROAD SUITE 228; BOX 24",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274076012",
            "telephone_number": "336-218-5176",
            "fax_number": "336-854-0279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 W. MEADOWVIEW ROAD SUITE 228",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274076012",
            "telephone_number": "336-218-5176",
            "fax_number": "336-854-0279"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3 Donlora Ct",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274076012",
            "country_code": "US",
            "telephone_number": "336-508-8190",
            "fax_number": "336-294-4893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRYSTAL E. NICKERSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-08",
        "last_updated": "2019-08-01",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-508-8190",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "373H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Day Training/Habilitation Specialist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1770813016",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "GREENSBORO",
            "affiliation": "N",
            "endpointDescription": "Therap, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "GREENSBORO",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2302 W. Meadowview Road Suite 228",
            "city": "GREENSBORO",
            "state": "NC",
            "country_code": "US",
            "postal_code": "27407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Choice Behavioral Health & Consultation Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Choice Behavioral Health & Consultation Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeronimo Manuel Cruz-Reyes, RN
• Juan Cruz-V
• Rikki Cruz, LCSW
• Shawnette Latrice Cruz, FNP
• Crystal Clear Speech and Language Services
• Crystal E.Nickerson, LLC
• Matthew Cuddington, M.A., CCC-SLP
• Meghan Lendry Culbertson
• Angela Francine Cullins, BSN, RN
• Marsha Devette Cullins, LCSWA, LCASA

• Community/Behavioral Health Agency in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2019; 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.