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NPI Code Detail

MEDICARE: NICOLE MARIE ERVIN MHCA.MC.70119748

MEDICARE: NICOLE MARIE ERVIN MHCA.MC.70119748
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorMHCA.MC.70119748WA
2101YA0400XAddiction (Substance Use Disorder) CounselorCO60561852WA

General Provider Information

NPI Number : 1568839942
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE ERVIN MHCA.MC.70119748
Provider Business Mailing Address
First Line : 8262 BALFOUR VALLEY LN
Second Line :
City : MAPLE FALLS
State : WA
Zip : 98266-7070
Country : US
Telephone Number : 360-441-3497
Fax Number :
Provider Business Practice Location Address
First Line : 1905 CONTINENTAL PL
Second Line :
City : MOUNT VERNON
State : WA
Zip : 98273-5633
Country : US
Telephone Number : 360-441-3497
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 05/25/2026

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