Provider Demographics
NPI:1063616522
Name:DAMERON, NINA B (MA, LPC, NCC)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:B
Last Name:DAMERON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 COUNTRY WOODS LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-1814
Mailing Address - Country:US
Mailing Address - Phone:336-294-0400
Mailing Address - Fax:336-641-6436
Practice Address - Street 1:232 N EDGEWORTH ST
Practice Address - Street 2:ROOM 224
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-2218
Practice Address - Country:US
Practice Address - Phone:336-641-6437
Practice Address - Fax:336-641-6436
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2864101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor