| Doctor Name: | MRS. NICOLE RENEE ROSE |
| NPI Number: | 1043580657 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A. LPCA |
| License Number: | A9177 |
| Business Practice Address: | 221 Barbour Street Clayton, NC - 27528 |
| Business Phone Number: | 9195500500 |
| Business Fax Number: | |
| Mailing Address: | 563 Averasboro Dr, CLAYTON |
| State: | NC |
| Postal Code: | 275202696 |
| Phone Number: | 9195856711 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2012 |
| NPI Last Update Date: | 01/12/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | A9177 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |