| Doctor Name: | MICHAEL W NUCKOLLS |
| NPI Number: | 1316238660 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NCC, LPC |
| License Number: | 8354 |
| Business Practice Address: | 1701 Harper Spring Dr Clemmons, NC - 270127417 |
| Business Phone Number: | 3367455087 |
| Business Fax Number: | |
| Mailing Address: | 4142 Robinhood Rd, WINSTON SALEM |
| State: | NC |
| Postal Code: | 271064739 |
| Phone Number: | 3367455087 |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2011 |
| NPI Last Update Date: | 01/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 8354 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |