Provider Demographics
NPI:1992239867
Name:MAZUR, NICHOLAS ANDREW (LCSW)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:MAZUR
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 US 70 E
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-8853
Mailing Address - Country:US
Mailing Address - Phone:252-294-4396
Mailing Address - Fax:
Practice Address - Street 1:140 US 70 E
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-8853
Practice Address - Country:US
Practice Address - Phone:252-294-4396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-17
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0101311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical