Provider Demographics
NPI:1003505504
Name:ROULEAU, NICOLE D (ADHD CCSP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:ROULEAU
Suffix:
Gender:F
Credentials:ADHD CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 113TH TER E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3709
Mailing Address - Country:US
Mailing Address - Phone:484-356-7195
Mailing Address - Fax:
Practice Address - Street 1:6316 113TH TER E
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3709
Practice Address - Country:US
Practice Address - Phone:484-356-7195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty