Provider Demographics
NPI:1326343302
Name:WATERS, NICOLE MONICA (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MONICA
Last Name:WATERS
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:MONICA
Other - Last Name:DUGGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15392 MURIETA SOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:RANCHO MURIETA
Mailing Address - State:CA
Mailing Address - Zip Code:95683-9180
Mailing Address - Country:US
Mailing Address - Phone:530-591-8383
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9494
Practice Address - Country:US
Practice Address - Phone:530-283-2465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF 72481106H00000X
CA91190106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health