Provider Demographics
NPI:1700496569
Name:DOZSA, NICOLE KRISTINA (LCSW, LCADCA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTINA
Last Name:DOZSA
Suffix:
Gender:F
Credentials:LCSW, LCADCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 W BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3245
Mailing Address - Country:US
Mailing Address - Phone:502-561-0943
Mailing Address - Fax:502-561-0944
Practice Address - Street 1:9720 PARK PLAZA AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2289
Practice Address - Country:US
Practice Address - Phone:502-938-0511
Practice Address - Fax:502-371-6110
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263297101YA0400X
KY2553891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)