Provider Demographics
NPI:1568479491
Name:NICOLL, MONICA ANNE (LMHC, MA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:ANNE
Last Name:NICOLL
Suffix:
Gender:F
Credentials:LMHC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SW SAINT LUCIE WEST BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2134
Mailing Address - Country:US
Mailing Address - Phone:772-785-6510
Mailing Address - Fax:772-785-6510
Practice Address - Street 1:1430 SW SAINT LUCIE WEST BLVD STE 103
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2134
Practice Address - Country:US
Practice Address - Phone:772-785-6510
Practice Address - Fax:772-785-6510
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health