Provider Demographics
NPI:1548408545
Name:HARTSON, NICOLE M (LPCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HARTSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 LOUISIANA BLVD NE STE 200D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3589
Mailing Address - Country:US
Mailing Address - Phone:505-397-4189
Mailing Address - Fax:505-397-4189
Practice Address - Street 1:2900 LOUISIANA BLVD NE STE 200D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3589
Practice Address - Country:US
Practice Address - Phone:505-397-4189
Practice Address - Fax:505-397-4189
Is Sole Proprietor?:No
Enumeration Date:2009-01-29
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0143191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional