Provider Demographics
NPI:1235642901
Name:DALTON, NICOLE ASHLEIGH (BA)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ASHLEIGH
Last Name:DALTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 NE OVERLOOK DR APT 1234
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-7213
Mailing Address - Country:US
Mailing Address - Phone:425-802-0122
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE STE 212
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-352-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health