Provider Demographics
NPI:1386110716
Name:KNOWLES, NICOLEE (LCSW,LCAS)
Entity type:Individual
Prefix:
First Name:NICOLEE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:LCSW,LCAS
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW,LCAS
Mailing Address - Street 1:260 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-3565
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4014 OLEANDER DR STE 103
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6811
Practice Address - Country:US
Practice Address - Phone:910-338-9197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-23489101YA0400X
NCC0127531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)