Provider Demographics
NPI:1225781313
Name:BURRITT, NICHOLE D (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:D
Last Name:BURRITT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3252
Mailing Address - Country:US
Mailing Address - Phone:814-558-2899
Mailing Address - Fax:
Practice Address - Street 1:21 WILDWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-3252
Practice Address - Country:US
Practice Address - Phone:814-558-2899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-31
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)