Provider Demographics
NPI:1578286449
Name:NICOLAS, IMMACULA NADEGE (RMHI)
Entity Type:Individual
Prefix:
First Name:IMMACULA
Middle Name:NADEGE
Last Name:NICOLAS
Suffix:
Gender:F
Credentials:RMHI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 LANDTREE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5958
Mailing Address - Country:US
Mailing Address - Phone:407-619-0803
Mailing Address - Fax:
Practice Address - Street 1:1600 E ROBINSON ST # 04251975
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5954
Practice Address - Country:US
Practice Address - Phone:407-423-3327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health