Provider Demographics
NPI:1518579929
Name:ASADI, NICOLE MARIE (MS, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:ASADI
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ALEXANDRIA PLACE DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4872
Mailing Address - Country:US
Mailing Address - Phone:614-725-6373
Mailing Address - Fax:
Practice Address - Street 1:722 TRADE WAY, SANFORD, FL 32771
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:407-863-4001
Practice Address - Fax:407-915-4387
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22378101YM0800X
OHC.1902371101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty