Provider Demographics
NPI:1396390373
Name:MCCABE, NICOLE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:MCCABE
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:PO BOX 32839
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99803-2839
Mailing Address - Country:US
Mailing Address - Phone:907-789-7610
Mailing Address - Fax:907-780-2456
Practice Address - Street 1:10801 BLACK BEAR ROAD
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8783
Practice Address - Country:US
Practice Address - Phone:907-789-7610
Practice Address - Fax:907-780-2456
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health