Provider Demographics
NPI:1043443443
Name:WEAVER, NICOLE (LMHP, PLADC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LMHP, PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 7TH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68850-1891
Mailing Address - Country:US
Mailing Address - Phone:308-520-4505
Mailing Address - Fax:
Practice Address - Street 1:200 W 7TH ST STE 3
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1891
Practice Address - Country:US
Practice Address - Phone:308-520-4505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-900101YA0400X
NE3917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)