Provider Demographics
NPI:1700434263
Name:HEWER, NICOLE LEA (LPCC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEA
Last Name:HEWER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEA
Other - Last Name:WOODALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6600 FRANCE AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1810
Mailing Address - Country:US
Mailing Address - Phone:952-460-9081
Mailing Address - Fax:952-835-9889
Practice Address - Street 1:6600 FRANCE AVE S STE 230
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1810
Practice Address - Country:US
Practice Address - Phone:952-460-9081
Practice Address - Fax:952-835-9889
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02201101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional