Provider Demographics
NPI:1669564183
Name:COGDILL, NICOLE MUJICA (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MUJICA
Last Name:COGDILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 BRUSHFIELD PARK DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8397
Mailing Address - Country:US
Mailing Address - Phone:251-635-2962
Mailing Address - Fax:
Practice Address - Street 1:434 BRUSHFIELD PARK DR
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8397
Practice Address - Country:US
Practice Address - Phone:251-635-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4789101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional