Provider Demographics
NPI:1790123933
Name:ROSS, NICHOLE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 FINANCIAL CENTRE PARKWAY
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4580
Mailing Address - Country:US
Mailing Address - Phone:501-749-2907
Mailing Address - Fax:
Practice Address - Street 1:10800 FINANCIAL CENTRE PKWY
Practice Address - Street 2:SUITE 290
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3552
Practice Address - Country:US
Practice Address - Phone:501-749-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health