Provider Demographics
NPI:1952943359
Name:NICHOLAS, NIKITA-CHARISMA JANELLE (LMHC, LPC, CAP)
Entity Type:Individual
Prefix:
First Name:NIKITA-CHARISMA
Middle Name:JANELLE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LMHC, LPC, CAP
Other - Prefix:
Other - First Name:CHARISMA
Other - Middle Name:
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHC, LPC, CAP
Mailing Address - Street 1:1065 NE 125TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:1601 N PALM AVE STE 211
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3204
Practice Address - Country:US
Practice Address - Phone:954-447-0010
Practice Address - Fax:954-447-0899
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
FLMH16832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty