Provider Demographics
NPI:1881338614
Name:CHRISTIAN, NICOLETTE
Entity type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4945 STATE ROUTE 339
Mailing Address - Street 2:
Mailing Address - City:VINCENT
Mailing Address - State:OH
Mailing Address - Zip Code:45784-5106
Mailing Address - Country:US
Mailing Address - Phone:750-818-3710
Mailing Address - Fax:
Practice Address - Street 1:4945 STATE ROUTE 339
Practice Address - Street 2:
Practice Address - City:VINCENT
Practice Address - State:OH
Practice Address - Zip Code:45784-5106
Practice Address - Country:US
Practice Address - Phone:750-818-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHCDCA.184748101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator