Provider Demographics
NPI:1609246354
Name:NICOPOLIS, MICHELLE (PHD, PCC, NCC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:NICOPOLIS
Suffix:
Gender:F
Credentials:PHD, PCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11565 PEARL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11565 PEARL RD
Practice Address - Street 2:SUITE #200
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-846-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8462101YP2500X
OH7259103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional