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NPI Code Detail

MEDICARE: NICOLE OLIVER LADC, CCS

MEDICARE: NICOLE OLIVER LADC, CCS
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCCS4675ME
2101YA0400XAddiction (Substance Use Disorder) CounselorLC4279ME

General Provider Information

NPI Number : 1609086388
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE OLIVER LADC, CCS
Provider Business Mailing Address
First Line : 13 CHELSEA WAY UNIT 234
Second Line :
City : CUMBERLAND FORESIDE
State : ME
Zip : 04110-1452
Country : US
Telephone Number : 207-214-9221
Fax Number :
Provider Business Practice Location Address
First Line : 13 CHELSEA WAY UNIT 234
Second Line :
City : CUMBERLAND FORESIDE
State : ME
Zip : 04110-1452
Country : US
Telephone Number : 207-214-9221
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 03/17/2018

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Directions to “ NICOLE OLIVER LADC, CCS” Practice Location

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