Provider Demographics
NPI:1194004622
Name:BOUIE, NICOLE LETRICE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LETRICE
Last Name:BOUIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 DANTE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-2956
Mailing Address - Country:US
Mailing Address - Phone:504-931-0549
Mailing Address - Fax:504-861-9072
Practice Address - Street 1:2219 DANTE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-2956
Practice Address - Country:US
Practice Address - Phone:504-931-0549
Practice Address - Fax:504-861-9072
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6170101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional