Provider Demographics
NPI:1760674170
Name:THWEATT, NICOLE M (PH D, LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:THWEATT
Suffix:
Gender:F
Credentials:PH D, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 LAKE HOWELL RD # 214
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1033
Mailing Address - Country:US
Mailing Address - Phone:407-587-5978
Mailing Address - Fax:407-926-0294
Practice Address - Street 1:2335 INAGUA WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-1629
Practice Address - Country:US
Practice Address - Phone:407-587-5978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9316101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health