Provider Demographics
NPI:1952775868
Name:MARTIN, NICHOLE LE ANN (CAADAC-CAS)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:LE ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CAADAC-CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5721
Mailing Address - Country:US
Mailing Address - Phone:916-442-4985
Mailing Address - Fax:916-442-1029
Practice Address - Street 1:2100 CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5721
Practice Address - Country:US
Practice Address - Phone:916-442-4985
Practice Address - Fax:916-442-1029
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6211214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)