Provider Demographics
NPI:1417136573
Name:BARAKAT, NICOLE MICHELE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MICHELE
Last Name:BARAKAT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:M
Other - Last Name:BRANDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:5294 STOCKYARD LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-8048
Mailing Address - Country:US
Mailing Address - Phone:201-539-1340
Mailing Address - Fax:
Practice Address - Street 1:9841 OCEAN HWY STE B
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7996
Practice Address - Country:US
Practice Address - Phone:843-481-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1647103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool