Provider Demographics
NPI:1184762361
Name:COTTON, NICOLE CLAUDETTE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CLAUDETTE
Last Name:COTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 HOYT ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3730
Mailing Address - Country:US
Mailing Address - Phone:503-689-1009
Mailing Address - Fax:
Practice Address - Street 1:1095 25TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-5049
Practice Address - Country:US
Practice Address - Phone:503-399-7400
Practice Address - Fax:503-399-7575
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)