Provider Demographics
NPI:1396511861
Name:NICOLE J. MALIE LLC
Entity type:Organization
Organization Name:NICOLE J. MALIE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:216-849-5334
Mailing Address - Street 1:33595 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2942
Mailing Address - Country:US
Mailing Address - Phone:216-849-5334
Mailing Address - Fax:
Practice Address - Street 1:33595 BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2942
Practice Address - Country:US
Practice Address - Phone:216-849-5334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty