Provider Demographics
NPI:1518609148
Name:COPELAND, NICOLE N (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:N
Last Name:COPELAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 LA MADERIA DR SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-1116
Mailing Address - Country:US
Mailing Address - Phone:321-412-1456
Mailing Address - Fax:
Practice Address - Street 1:1600 SARNO RD STE 117
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4992
Practice Address - Country:US
Practice Address - Phone:321-622-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional