Provider Demographics
NPI:1023859709
Name:BILLINGSLEA, NICOLE (QMHP-T)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BILLINGSLEA
Suffix:
Gender:F
Credentials:QMHP-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 WASHINGTON ST APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2446
Mailing Address - Country:US
Mailing Address - Phone:716-450-7770
Mailing Address - Fax:
Practice Address - Street 1:348 WASHINGTON ST APT 5
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2446
Practice Address - Country:US
Practice Address - Phone:716-450-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0734005062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health