Provider Demographics
NPI:1578996955
Name:MACDONALD, NICOLE MICHELLE (LPCC, LCMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MICHELLE
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:LPCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 CENTRAL AVE
Mailing Address - Street 2:#5
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2506
Mailing Address - Country:US
Mailing Address - Phone:650-766-2088
Mailing Address - Fax:
Practice Address - Street 1:21 BIRCHWOOD DR
Practice Address - Street 2:
Practice Address - City:RYE
Practice Address - State:NH
Practice Address - Zip Code:03870-2321
Practice Address - Country:US
Practice Address - Phone:650-766-2088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1034101YM0800X
CA469101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health