Provider Demographics
NPI:1851489579
Name:CULLY, NYCOLE TILISA (BA)
Entity Type:Individual
Prefix:MS
First Name:NYCOLE
Middle Name:TILISA
Last Name:CULLY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:115 ARRAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6404
Mailing Address - Country:US
Mailing Address - Phone:909-212-4437
Mailing Address - Fax:909-212-4437
Practice Address - Street 1:9445 FARNHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1308
Practice Address - Country:US
Practice Address - Phone:858-380-4676
Practice Address - Fax:858-380-4676
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health