Provider Demographics
NPI:1720104128
Name:MIKOLASCHEK, NANCY SCOTT (LPC)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:SCOTT
Last Name:MIKOLASCHEK
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 1:185 W LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7928
Mailing Address - Country:US
Mailing Address - Phone:256-971-1673
Mailing Address - Fax:
Practice Address - Street 1:115 MANNING DR SW
Practice Address - Street 2:SUITE 210 B
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4315
Practice Address - Country:US
Practice Address - Phone:256-519-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1367101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor