Provider Demographics
NPI:1609416692
Name:DUBUISSON, NICHOLE CHRISTINE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:CHRISTINE
Last Name:DUBUISSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12233 SMOKEY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34669-2775
Mailing Address - Country:US
Mailing Address - Phone:727-846-2434
Mailing Address - Fax:
Practice Address - Street 1:12233 SMOKEY DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34669-2775
Practice Address - Country:US
Practice Address - Phone:727-846-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker