Provider Demographics
NPI:1790087807
Name:BREWER, NICOLE MARIE (CPC, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:BREWER
Suffix:
Gender:F
Credentials:CPC, LCADC
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:WEATHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPC, LCADC
Mailing Address - Street 1:2470 SAINT ROSE PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7774
Mailing Address - Country:US
Mailing Address - Phone:702-496-6562
Mailing Address - Fax:702-993-8283
Practice Address - Street 1:2470 SAINT ROSE PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7774
Practice Address - Country:US
Practice Address - Phone:702-496-6562
Practice Address - Fax:702-993-8283
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV323-LC101YA0400X
NVCP0069101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1041C0700XMedicaid