Provider Demographics
NPI:1356886204
Name:NONCLERC, NICOLE (MS, LMHC, MCAP, NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NONCLERC
Suffix:
Gender:F
Credentials:MS, LMHC, MCAP, NCC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BRENNEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1850 PROVIDENCE LAKES BLVD APT 816
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-1843
Mailing Address - Country:US
Mailing Address - Phone:813-376-0518
Mailing Address - Fax:
Practice Address - Street 1:1134 BELL SHOALD ROAD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-315-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-02
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 100016101YA0400X
FLMH15132101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021221300Medicaid
14031390OtherCAQH