Provider Demographics
NPI:1134683386
Name:COSTELLO, NICOLE ANNE (LMHC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ANNE
Last Name:COSTELLO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5219
Mailing Address - Country:US
Mailing Address - Phone:407-922-2325
Mailing Address - Fax:
Practice Address - Street 1:220 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-5219
Practice Address - Country:US
Practice Address - Phone:407-922-2325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9643101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health