Provider Demographics
NPI:1275000960
Name:WILLIAMS, NICOLE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:2024 BRIDGEPORT DR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-8533
Mailing Address - Country:US
Mailing Address - Phone:860-913-3804
Mailing Address - Fax:
Practice Address - Street 1:2024 BRIDGEPORT DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-8533
Practice Address - Country:US
Practice Address - Phone:860-913-3804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-18-31850103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst