Provider Demographics
NPI:1801361969
Name:WEBB, NICOLE EVANGELINE (AMFT, APCCI)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EVANGELINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:AMFT, APCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 DON TOMASO DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5348
Mailing Address - Country:US
Mailing Address - Phone:323-206-2929
Mailing Address - Fax:
Practice Address - Street 1:5825 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4612
Practice Address - Country:US
Practice Address - Phone:323-933-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)