Provider Demographics
NPI:1760019731
Name:WATERS, NICOLE (LMHCA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 23RD AVE APT B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2950
Mailing Address - Country:US
Mailing Address - Phone:480-459-1258
Mailing Address - Fax:
Practice Address - Street 1:1904 3RD AVE STE 229
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1194
Practice Address - Country:US
Practice Address - Phone:206-485-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAM61010245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health