Provider Demographics
NPI:1659733368
Name:MONAHAN, NICHOLE A (MSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:A
Last Name:MONAHAN
Suffix:
Gender:F
Credentials:MSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 TRANSVERSE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-8008
Mailing Address - Country:US
Mailing Address - Phone:419-383-5671
Mailing Address - Fax:419-383-3183
Practice Address - Street 1:3125 TRANSVERSE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-5671
Practice Address - Fax:419-383-3183
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140807101YA0400X
OHI.16002911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178709Medicaid