Provider Demographics
NPI:1326881731
Name:WOLVERTON, NANCY T (SUDRC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:T
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 COURTLAND ST APT A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6233
Mailing Address - Country:US
Mailing Address - Phone:336-269-4943
Mailing Address - Fax:
Practice Address - Street 1:609 COURTLAND ST APT A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6233
Practice Address - Country:US
Practice Address - Phone:336-269-4943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16055101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)