Provider Demographics
NPI:1740153295
Name:COKRLIC, NICHOLE SUZANNE (CSW)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:SUZANNE
Last Name:COKRLIC
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8357A NICHOLS ST
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-3860
Mailing Address - Country:US
Mailing Address - Phone:210-935-8108
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-2079
Practice Address - Country:US
Practice Address - Phone:931-408-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health