Provider Demographics
NPI:1265592927
Name:HADDAK, NICOLA (LMHC)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:HADDAK
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 1:1938 SOULE ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759
Mailing Address - Country:US
Mailing Address - Phone:727-726-7442
Mailing Address - Fax:727-288-1111
Practice Address - Street 1:1938 SOULE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1507
Practice Address - Country:US
Practice Address - Phone:727-724-7442
Practice Address - Fax:727-288-1111
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH8832OtherLICENSE