Provider Demographics
NPI:1215413646
Name:DAMROW, NICOLE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DAMROW
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-IT
Mailing Address - Street 1:2270 HOLMGREN WAY
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-4710
Mailing Address - Country:US
Mailing Address - Phone:920-544-5294
Mailing Address - Fax:
Practice Address - Street 1:2270 HOLMGREN WAY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4710
Practice Address - Country:US
Practice Address - Phone:920-544-5294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4001-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional