Provider Demographics
NPI:1801361969
Name:WEBB, NICOLE EVANGELINE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EVANGELINE
Last Name:WEBB
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 DON TOMASO DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5348
Mailing Address - Country:US
Mailing Address - Phone:323-206-2929
Mailing Address - Fax:
Practice Address - Street 1:4245 DON TOMASO DR APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5348
Practice Address - Country:US
Practice Address - Phone:323-933-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA106H00000X
CA124785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)