Provider Demographics
NPI:1679662670
Name:ATTONG, NICOLE ANN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANN
Last Name:ATTONG
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 1:12810 SW 105TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3503
Mailing Address - Country:US
Mailing Address - Phone:305-773-9042
Mailing Address - Fax:305-349-1231
Practice Address - Street 1:10300 SOUTHWEST 72ND AVENUE
Practice Address - Street 2:SUITE 153
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-773-9042
Practice Address - Fax:305-349-1231
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health