Provider Demographics
NPI:1548746027
Name:GREENWOOD, NICOLE (LMFT126008, APCC6647)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
Credentials:LMFT126008, APCC6647
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BOZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT114454 APCC6647
Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95609-3087
Mailing Address - Country:US
Mailing Address - Phone:916-258-2187
Mailing Address - Fax:
Practice Address - Street 1:2617 K ST STE 125
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5133
Practice Address - Country:US
Practice Address - Phone:916-258-2187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist