Provider Demographics
NPI:1447048178
Name:NICOLL, MACARA MARIE
Entity type:Individual
Prefix:
First Name:MACARA
Middle Name:MARIE
Last Name:NICOLL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 CALAVERAS AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3071
Mailing Address - Country:US
Mailing Address - Phone:530-757-5430
Mailing Address - Fax:530-757-5434
Practice Address - Street 1:2121 CALAVERAS AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3071
Practice Address - Country:US
Practice Address - Phone:530-757-5430
Practice Address - Fax:530-757-5434
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor