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ANDREA MICHELLE NICOLES MSW

>> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1366618365

Individual Registrant:
 ANDREA MICHELLE NICOLES MSW
Gender: F
Not Sole Proprietor

Location and contact information for practice:
118 N SALLY DR  WINAMAC, IN 46996-9100 US
Tel: 574-946-4233  Fax: 574-946-4365

Contact information for business:
1015 MICHIGAN AVE  LOGANSPORT, IN 46947-1526 US
Tel: 574-722-5151  Fax: 574-739-1414

Registration Information:
NPI: 1366618365
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N101Y00000XBehavioral Health & Social Service Providers
Counselor
Y104100000XBehavioral Health & Social Service Providers
Social Worker
N171M00000XOther Service Providers
Case Manager/Care Coordinator

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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