Provider Demographics
NPI:1306182027
Name:WILLIAMS, NICOLE S (LPC, MA,BA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPC, MA,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3764
Mailing Address - Country:US
Mailing Address - Phone:203-806-0820
Mailing Address - Fax:
Practice Address - Street 1:210 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3764
Practice Address - Country:US
Practice Address - Phone:203-806-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13759277OtherCAQH
CT060669107OtherUBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CTNOT ELIGIBLEMedicare UPIN
CT060669107OtherUNITED BEHAVIORAL HEALTH-OPTUM WELLMORE GRP/FACILITY
CTD339209 141 E MAINOtherBEACON HEALTH OPTIONS, INC WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGOtherCAQH
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CTNOT ELIGIBLEOtherMHN TRICARE NORTH
CTPENDINGMedicaid