Provider Demographics
NPI:1962440958
Name:SALTER, NICOLE DESIREE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:DESIREE
Last Name:SALTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:DESIREE
Other - Last Name:RING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3250 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-7748
Mailing Address - Country:US
Mailing Address - Phone:928-341-0335
Mailing Address - Fax:
Practice Address - Street 1:3250 E 40TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7748
Practice Address - Country:US
Practice Address - Phone:928-341-0335
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-103411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ697865OtherAHCCCS #
AZ697865OtherAHCCCS #