Provider Demographics
NPI:1871661918
Name:LEE, NICOLETTE CRYSTAL (MSW, LCSW)
Entity Type:Individual
Prefix:MISS
First Name:NICOLETTE
Middle Name:CRYSTAL
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:NICOLETTE
Other - Middle Name:LEE
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 59057
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95159-0057
Mailing Address - Country:US
Mailing Address - Phone:650-409-5255
Mailing Address - Fax:650-409-5410
Practice Address - Street 1:441 N CENTRAL AVE STE 11
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:541-639-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA82860101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health