Provider Demographics
NPI:1265674915
Name:CREIGHTON, NICOLE R (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:CREIGHTON
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 1:2727 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 224
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3750
Mailing Address - Country:US
Mailing Address - Phone:619-993-4737
Mailing Address - Fax:619-578-2727
Practice Address - Street 1:2727 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 224
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3750
Practice Address - Country:US
Practice Address - Phone:619-993-4737
Practice Address - Fax:619-578-2727
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist