Provider Demographics
NPI:1811538317
Name:MCDONAGH, NICOLE (CPC-I, LADC, CHT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MCDONAGH
Suffix:
Gender:F
Credentials:CPC-I, LADC, CHT
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MCDONAGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPC-I, LADC, CHT
Mailing Address - Street 1:2520 SAINT ROSE PKWY STE 220A
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7789
Mailing Address - Country:US
Mailing Address - Phone:702-483-1990
Mailing Address - Fax:
Practice Address - Street 1:2520 SAINT ROSE PKWY STE 220A
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7789
Practice Address - Country:US
Practice Address - Phone:702-483-1990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV06639-L101YA0400X
NV02500-I101YA0400X
NVC12852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty