Provider Demographics
NPI:1750952313
Name:PERDUE, NICOLE JANE (MS CRC LPC-INTERN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JANE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:MS CRC LPC-INTERN
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JANE
Other - Last Name:WOOLSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CRC LPC-INTERN
Mailing Address - Street 1:520 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-2627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 RIDGEWAY DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6544
Practice Address - Country:US
Practice Address - Phone:541-505-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00282521225C00000X
ORR6596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor