Provider Demographics
NPI:1720581192
Name:NICOLA COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:NICOLA COUNSELING SERVICES, LLC
Other - Org Name:WIDIAN NICOLA COUNSELING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WIDIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LCSW
Authorized Official - Phone:360-904-9363
Mailing Address - Street 1:61 PRINCETON HIGHTSTOWN RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1120
Mailing Address - Country:US
Mailing Address - Phone:360-904-9363
Mailing Address - Fax:
Practice Address - Street 1:61 PRINCETON HIGHTSTOWN RD STE 1C
Practice Address - Street 2:
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1120
Practice Address - Country:US
Practice Address - Phone:360-904-9363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)