Provider Demographics
NPI:1578331542
Name:HIGHLAND, NICKOLUS
Entity Type:Individual
Prefix:
First Name:NICKOLUS
Middle Name:
Last Name:HIGHLAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 IVORY WAY
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9515
Mailing Address - Country:US
Mailing Address - Phone:517-626-0371
Mailing Address - Fax:
Practice Address - Street 1:72 HINCHEY RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2930
Practice Address - Country:US
Practice Address - Phone:585-467-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)