Provider Demographics
NPI:1982949392
Name:SEITZ, NICOLE M (LPC (PA) LPCC NM))
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:SEITZ
Suffix:
Gender:F
Credentials:LPC (PA) LPCC NM)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5605
Mailing Address - Country:US
Mailing Address - Phone:267-971-5729
Mailing Address - Fax:
Practice Address - Street 1:313 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4908
Practice Address - Country:US
Practice Address - Phone:267-971-5729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006500101YP2500X
NMCCMH0175511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional