Provider Demographics
NPI:1255930640
Name:MOORMAN, NIKKI LYNN (LPC)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:MOORMAN
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 1:5409 GATEWAY CTR STE E
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3992
Mailing Address - Country:US
Mailing Address - Phone:810-584-5951
Mailing Address - Fax:
Practice Address - Street 1:5409 GATEWAY CTR STE E
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3992
Practice Address - Country:US
Practice Address - Phone:810-584-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-18
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451015089101Y00000X
MI6401223173101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty