Provider Demographics
NPI:1609082254
Name:DEEMS, NICOLE S (EDS, LMFT, LAC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:DEEMS
Suffix:
Gender:F
Credentials:EDS, LMFT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 DROOPING LEAF RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-6880
Mailing Address - Country:US
Mailing Address - Phone:803-600-2682
Mailing Address - Fax:
Practice Address - Street 1:311 MEETZE AVE STE H
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2625
Practice Address - Country:US
Practice Address - Phone:803-470-3786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1102249101YA0400X
SC4518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)