Provider Demographics
NPI:1629128012
Name:BOUCHER, NOMPELELO KHUMALO (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NOMPELELO
Middle Name:KHUMALO
Last Name:BOUCHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RUSTIC LN
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-1141
Mailing Address - Country:US
Mailing Address - Phone:617-791-2645
Mailing Address - Fax:
Practice Address - Street 1:68 CUMBERLAND STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-5449
Practice Address - Country:US
Practice Address - Phone:401-356-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00708101YM0800X
MA9201101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health