Provider Demographics
NPI:1821443680
Name:JUSTICE, NICOLE (LPCMH, DVS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:JUSTICE
Suffix:
Gender:F
Credentials:LPCMH, DVS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCMH
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19903-1292
Mailing Address - Country:US
Mailing Address - Phone:302-526-7129
Mailing Address - Fax:
Practice Address - Street 1:9 E LOOCKERMAN ST STE 302
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-8305
Practice Address - Country:US
Practice Address - Phone:302-492-6129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-29
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000870101YM0800X
DE76657101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool