Provider Demographics
NPI:1407158165
Name:BUDDLE-DIAZ, NICOLE E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:E
Last Name:BUDDLE-DIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 LAKEVIEW PKWY STE 700
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-9066
Mailing Address - Country:US
Mailing Address - Phone:678-699-6208
Mailing Address - Fax:678-916-3810
Practice Address - Street 1:2300 LAKEVIEW PKWY STE 700
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-9066
Practice Address - Country:US
Practice Address - Phone:678-699-6208
Practice Address - Fax:678-916-3810
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 3256101YA0400X
FLSW69861041C0700X
GACSW0041301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)