Provider Demographics
NPI:1245590843
Name:UNSWORTH, NICOLE JACQUELYN (LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:JACQUELYN
Last Name:UNSWORTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CAMINO DE LA REINA UNIT 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5515
Mailing Address - Country:US
Mailing Address - Phone:480-296-6221
Mailing Address - Fax:
Practice Address - Street 1:2050 CAMINO DE LA REINA UNIT 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-5515
Practice Address - Country:US
Practice Address - Phone:480-296-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health