Provider Demographics
NPI:1699025783
Name:THOLMER, NICOLE A (LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:THOLMER
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 1:2470 WINDY HILL RD SE STE 252
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8619
Mailing Address - Country:US
Mailing Address - Phone:770-765-1652
Mailing Address - Fax:678-426-8464
Practice Address - Street 1:1713 WYNNDOWNE TRL SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-2480
Practice Address - Country:US
Practice Address - Phone:404-909-7113
Practice Address - Fax:770-437-8413
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-15
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006965101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003204125AMedicaid