Crystal E.Nickerson, LLC

Primary specialty

Respite CareTaxonomy code 385H00000X

Legal business name

CRYSTAL E.NICKERSON, LLC

Doing business as

Choice Behavioral Health & Consultation Services

Practice address

2302 W Meadowview Rd
Suite 228, Box 24
Greensboro, NC 27407-3721

Phone

(336) 617-0764

Fax

(336) 617-0964

NPI assigned

Jan 5, 2012

Last updated

Jan 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Crystal Eyvette Nickerson, BA

Title

Director

Phone

(336) 617-0764

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Choice Behavioral Health & Consultation Services Doing business as

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

  dba Choice Behavioral Health & Consultation Services

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1770813016
  NPD tax ID

Locations

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

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1932479045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 W MEADOWVIEW RD",
            "address_2": "SUITE 228, BOX 24",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073721",
            "telephone_number": "336-617-0764",
            "fax_number": "336-617-0964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 W MEADOWVIEW RD",
            "address_2": "SUITE 228, BOX 24",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274073721",
            "telephone_number": "336-617-0764",
            "fax_number": "336-617-0964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL E.NICKERSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "NICKERSON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "EYVETTE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-617-0764",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA"
    },
    "taxonomies": [
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3418853",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8702219",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Choice Behavioral Health & Consultation Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Juan Cruz-V
• Rikki Cruz, LCSW
• Shawnette Latrice Cruz, FNP
• Crystal Clear Speech and Language Services
• Crystal E. Nickerson (Choice Behavioral Health & Consultation Services)
• Matthew Cuddington, M.A., CCC-SLP
• Meghan Lendry Culbertson
• Angela Francine Cullins, BSN, RN
• Marsha Devette Cullins, LCSWA, LCASA
• Mya S Cullins, MS, LCASA

• Respite Care in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Respite Care in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; 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.