Provider Demographics
NPI:1932356482
Name:NICOLAIDES, NINA CORINNE (LPC)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:CORINNE
Last Name:NICOLAIDES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13122 LA VENTANA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5851
Mailing Address - Country:US
Mailing Address - Phone:210-396-9109
Mailing Address - Fax:
Practice Address - Street 1:8703 WURZBACH RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1160
Practice Address - Country:US
Practice Address - Phone:210-561-1516
Practice Address - Fax:210-561-1512
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62278101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional