Provider Demographics
NPI:1811538317
Name:MCDONAGH, NICOLE (CPC, LCADC, LCADC-S)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:MCDONAGH
Suffix:
Gender:F
Credentials:CPC, LCADC, LCADC-S
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:MCDONAGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPC, LCADC, LCADC-S
Mailing Address - Street 1:6362 MCLEOD DR STE 6
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4433
Mailing Address - Country:US
Mailing Address - Phone:702-483-1990
Mailing Address - Fax:702-831-8812
Practice Address - Street 1:6362 MCLEOD DR STE 6
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4433
Practice Address - Country:US
Practice Address - Phone:702-483-1990
Practice Address - Fax:702-831-8812
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-05
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV07378-LC101YA0400X
NV07517LCS101YA0400X
NV3215-21374J00000X
NVCP5377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty