Provider Demographics
NPI:1831747377
Name:WARD, NICOLE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18685 MAIN ST STE 101-459
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1723
Mailing Address - Country:US
Mailing Address - Phone:714-697-1907
Mailing Address - Fax:714-464-4555
Practice Address - Street 1:2845 MESA VERDE DR E STE 9
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4858
Practice Address - Country:US
Practice Address - Phone:714-697-1907
Practice Address - Fax:714-464-4555
Is Sole Proprietor?:No
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst