Provider Demographics
NPI:1083901334
Name:GATLIN, NICOLE WASHINGTON (LPC, CRC, NCACII)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:WASHINGTON
Last Name:GATLIN
Suffix:
Gender:F
Credentials:LPC, CRC, NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1584 CARLTON RD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:31738-2656
Mailing Address - Country:US
Mailing Address - Phone:310-906-5431
Mailing Address - Fax:229-226-4755
Practice Address - Street 1:14382 US HIGHWAY 19 S
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31757-4801
Practice Address - Country:US
Practice Address - Phone:229-228-5545
Practice Address - Fax:229-226-4755
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1994101YA0400X
00111394225C00000X
LPC008434101YP2500X
GALPC008434101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor