Provider Demographics
NPI:1417594045
Name:MOMAN, NICOLE M (LCMHC, NCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:MOMAN
Suffix:
Gender:F
Credentials:LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WALNUT HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-8584
Mailing Address - Country:US
Mailing Address - Phone:285-533-8758
Mailing Address - Fax:888-717-5718
Practice Address - Street 1:6 PARK PL W
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3081
Practice Address - Country:US
Practice Address - Phone:828-553-3875
Practice Address - Fax:888-717-5718
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12569101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health