Provider Demographics
NPI:1275212557
Name:FLETCHER, NICOLE MARIE (CSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:NICKI
Other - Middle Name:MARIE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CSW
Mailing Address - Street 1:626 WALLACE DEAN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7749
Mailing Address - Country:US
Mailing Address - Phone:318-237-9250
Mailing Address - Fax:
Practice Address - Street 1:2106 N 7TH ST
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-4445
Practice Address - Country:US
Practice Address - Phone:318-577-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16854104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker