Provider Demographics
NPI:1164676789
Name:DENMAN, NICOLE T (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:T
Last Name:DENMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 CHEROKEE ST NW
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6524
Mailing Address - Country:US
Mailing Address - Phone:770-627-3550
Mailing Address - Fax:
Practice Address - Street 1:3114 CHEROKEE ST NW
Practice Address - Street 2:SUITE 209
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6524
Practice Address - Country:US
Practice Address - Phone:770-627-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0600467101YP2500X
GALPC005777101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA927317302AMedicaid