Provider Demographics
NPI:1184151722
Name:PFAFF, NICOLE MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:PFAFF
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545
Mailing Address - Country:US
Mailing Address - Phone:484-477-8223
Mailing Address - Fax:
Practice Address - Street 1:112 S MAIN STREET
Practice Address - Street 2:SUITE C
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545
Practice Address - Country:US
Practice Address - Phone:484-477-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-14
Last Update Date:2018-10-19
Deactivation Date:2018-09-28
Deactivation Code:
Reactivation Date:2018-10-19
Provider Licenses
StateLicense IDTaxonomies
PAPC009626101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health