Provider Demographics
NPI:1639591852
Name:SUBLETTE, NICOLE (LCMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SUBLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHC
Mailing Address - Street 1:2 WALL ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1518
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:603-628-7757
Practice Address - Street 1:1 ARCH PL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH2067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health