| Doctor Name: | DR. CHARLEENE VIRGINIA NICELY |
| NPI Number: | 1780852160 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | AD003667 |
| Business Practice Address: | 241 Pavillon Pl Mill Spring, NC - 287565809 |
| Business Phone Number: | 8003924808 |
| Business Fax Number: | 8286942301 |
| Mailing Address: | 241 Pavillon Pl, MILL SPRING |
| State: | NC |
| Postal Code: | 287565809 |
| Phone Number: | 8003924808 |
| Fax Number: | 8286942301 |
| NPI Enumeration Date: | 02/19/2008 |
| NPI Last Update Date: | 02/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | AD003667 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |