Provider Demographics
NPI:1790299881
Name:WOOD, NICOLE WALKER (MA, LPC, NCC, CPCS)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:WALKER
Last Name:WOOD
Suffix:
Gender:F
Credentials:MA, LPC, NCC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 RIVER PARK NORTH DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-7835
Mailing Address - Country:US
Mailing Address - Phone:678-539-0281
Mailing Address - Fax:
Practice Address - Street 1:255 VILLAGE PKWY NE STE 580
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4161
Practice Address - Country:US
Practice Address - Phone:770-726-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
GALPC008388101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor