Provider Demographics
NPI:1689801938
Name:LADSON, NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LADSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218A SUNSET RD
Mailing Address - Street 2:SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1110
Mailing Address - Country:US
Mailing Address - Phone:609-835-6180
Mailing Address - Fax:609-835-7962
Practice Address - Street 1:218A SUNSET RD
Practice Address - Street 2:SCREENING, CRISIS & INTERVENTION PROGRAM (SCIP)
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1110
Practice Address - Country:US
Practice Address - Phone:609-835-6180
Practice Address - Fax:609-835-7962
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-14
Last Update Date:2009-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NJ37PC00368500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist