Provider Demographics
NPI:1740653500
Name:NANCE, NICOLETTA C (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:NICOLETTA
Middle Name:C
Last Name:NANCE
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 S THOROUGHBRED PT
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-9523
Mailing Address - Country:US
Mailing Address - Phone:352-302-7872
Mailing Address - Fax:
Practice Address - Street 1:11403 SE US HIGHWAY 301
Practice Address - Street 2:SUITE 8
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4469
Practice Address - Country:US
Practice Address - Phone:352-302-7872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health