Provider Demographics
NPI:1033399001
Name:STOKES, NICOLE (SSP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 N 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-8376
Mailing Address - Country:US
Mailing Address - Phone:623-535-6335
Mailing Address - Fax:
Practice Address - Street 1:553 E PLAZA CIR
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4930
Practice Address - Country:US
Practice Address - Phone:623-535-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool