Provider Demographics
NPI:1205381514
Name:LOEW, NIKOLE (PCC S)
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:LOEW
Suffix:
Gender:F
Credentials:PCC S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8494 LAZELLE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8853
Mailing Address - Country:US
Mailing Address - Phone:740-816-7014
Mailing Address - Fax:
Practice Address - Street 1:8494 LAZELLE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8853
Practice Address - Country:US
Practice Address - Phone:740-816-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0500229101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional