Provider Demographics
NPI:1215820584
Name:CARTER, NICOLE MARIE (PPS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:CARTER
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:DURAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 E J ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6115
Mailing Address - Country:US
Mailing Address - Phone:619-425-9600
Mailing Address - Fax:619-425-9600
Practice Address - Street 1:84 E J ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6115
Practice Address - Country:US
Practice Address - Phone:619-425-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240134674101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool