Provider Demographics
NPI:1326580846
Name:APPLEWHITE, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:APPLEWHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DOWNSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71234-5700
Mailing Address - Country:US
Mailing Address - Phone:318-789-6819
Mailing Address - Fax:
Practice Address - Street 1:122 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DOWNSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71234-5700
Practice Address - Country:US
Practice Address - Phone:318-789-6819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA7408101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator