Provider Demographics
NPI:1760049431
Name:DUNBAR, NICOLE (NCC,LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 AMITY AVE
Mailing Address - Street 2:
Mailing Address - City:OLD FORGE
Mailing Address - State:PA
Mailing Address - Zip Code:18518-1034
Mailing Address - Country:US
Mailing Address - Phone:570-313-6098
Mailing Address - Fax:
Practice Address - Street 1:228 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504
Practice Address - Country:US
Practice Address - Phone:570-904-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011437101YP2500X
101YP2500X
PC011437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional