Provider Demographics
NPI:1790519098
Name:COTTERILL, NICOLE ERIN (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ERIN
Last Name:COTTERILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 N COLT LN APT A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1740
Mailing Address - Country:US
Mailing Address - Phone:425-903-0823
Mailing Address - Fax:
Practice Address - Street 1:6040 N COLT LN APT A
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-1740
Practice Address - Country:US
Practice Address - Phone:425-903-0823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-22020104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker