Most Relevant Information
Provider Data
| NPI Number: | 1003381203 |
| Provider Name: | NICOLLA MARTIN LCSW-A |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/04/2018 |
| Last Updated: | 09/10/2021 |
Provider Practice Location
769 N WENDOVER RD
CHARLOTTE
NC
282111118
Practice Location Phone/Fax
| Phone: | 7043767180 |
| Fax: |
Provider Mailing Location
769 N WENDOVER RD
CHARLOTTE
NC
282111118
Provider Mailing Phone/Fax
| Phone: | 7043767180 |
| Fax: |