Provider Demographics
NPI:1811225485
Name:STORY, NICOLE POLLOCK (EDS, LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:POLLOCK
Last Name:STORY
Suffix:
Gender:F
Credentials:EDS, LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E BAY ST STE 920
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-3434
Mailing Address - Country:US
Mailing Address - Phone:904-234-0574
Mailing Address - Fax:
Practice Address - Street 1:808 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-5080
Practice Address - Country:US
Practice Address - Phone:904-234-0574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7433101YM0800X
FLMT2208106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health