Provider Demographics
NPI:1457582405
Name:BROWNING, NICOLE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BROWNING
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 LOCKPORT DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2130
Mailing Address - Country:US
Mailing Address - Phone:636-734-0953
Mailing Address - Fax:
Practice Address - Street 1:1050 CROWN POINTE PKWY STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-7702
Practice Address - Country:US
Practice Address - Phone:678-534-7625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.005312101YA0400X
IL180.007401101YP2500X
MO2012012906101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)