Provider Demographics
NPI:1104360171
Name:WINT, NICOLE ANDREA
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANDREA
Last Name:WINT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:ANDREA
Other - Last Name:WINT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, MSW, LSWAIC, MHP
Mailing Address - Street 1:112 VIVIAN LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-2305
Mailing Address - Country:US
Mailing Address - Phone:470-667-0160
Mailing Address - Fax:
Practice Address - Street 1:112 VIVIAN LN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-2305
Practice Address - Country:US
Practice Address - Phone:706-670-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2023-01-04
Deactivation Date:2022-12-09
Deactivation Code:
Reactivation Date:2022-12-30
Provider Licenses
StateLicense IDTaxonomies
WASC60819452101YM0800X
GACSW0078431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical