Provider Demographics
NPI:1013542182
Name:HERTING, NICOLA ASHTON (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:ASHTON
Last Name:HERTING
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 4TH ST S STE 302
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1937
Mailing Address - Country:US
Mailing Address - Phone:651-274-1647
Mailing Address - Fax:
Practice Address - Street 1:100 4TH ST S STE 302
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1937
Practice Address - Country:US
Practice Address - Phone:701-234-4587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND558103TC0700X
103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical