Provider Demographics
NPI:1477263200
Name:NICOLE THOLMER, LPC LLC
Entity Type:Organization
Organization Name:NICOLE THOLMER, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOLMER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:770-765-1652
Mailing Address - Street 1:3316A S COBB DR SE STE 221
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4118
Mailing Address - Country:US
Mailing Address - Phone:770-765-1652
Mailing Address - Fax:678-426-8464
Practice Address - Street 1:112 CUMBERLAND GATE SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7705
Practice Address - Country:US
Practice Address - Phone:770-765-1652
Practice Address - Fax:678-426-8464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-02
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204125AMedicaid