Provider Demographics
NPI:1043104656
Name:PLUM, NICHOLE (PLADC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:PLUM
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2946
Mailing Address - Country:US
Mailing Address - Phone:402-251-2049
Mailing Address - Fax:402-341-6218
Practice Address - Street 1:1941 S 42ND ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2946
Practice Address - Country:US
Practice Address - Phone:402-251-2049
Practice Address - Fax:402-341-6218
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)