Provider Demographics
NPI:1134662562
Name:JOYCE, NICHOLE (MA, SAC-IT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:JOYCE
Suffix:
Gender:F
Credentials:MA, SAC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220-4573
Mailing Address - Country:US
Mailing Address - Phone:920-250-5738
Mailing Address - Fax:920-250-5736
Practice Address - Street 1:6510 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4573
Practice Address - Country:US
Practice Address - Phone:920-250-5738
Practice Address - Fax:920-250-5736
Is Sole Proprietor?:No
Enumeration Date:2016-12-03
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18005-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)