Provider Demographics
NPI:1598444515
Name:WILLIAMS, NICOLE R (MS, LPC, EDS)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LPC, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 IMANI CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-8404
Mailing Address - Country:US
Mailing Address - Phone:419-654-7067
Mailing Address - Fax:
Practice Address - Street 1:2602 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-3241
Practice Address - Country:US
Practice Address - Phone:419-318-9121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health