Provider Demographics
NPI:1629646245
Name:RIHANEK, NICOLE RENEE (SUDPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:RIHANEK
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 149TH PL NE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-8977
Mailing Address - Country:US
Mailing Address - Phone:425-208-6811
Mailing Address - Fax:
Practice Address - Street 1:11627 AIRPORT RD STE B
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-8714
Practice Address - Country:US
Practice Address - Phone:425-248-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61177476101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)