Provider Demographics
NPI:1609086388
Name:OLIVER, NICOLE (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 CHELSEA WAY UNIT 234
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1452
Mailing Address - Country:US
Mailing Address - Phone:207-214-9221
Mailing Address - Fax:
Practice Address - Street 1:13 CHELSEA WAY UNIT 234
Practice Address - Street 2:
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1452
Practice Address - Country:US
Practice Address - Phone:207-214-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECCS4675101YA0400X
MELC4279101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)