Healthcare Provider Details

I. General information

NPI: 1356015937
Provider Name (Legal Business Name): NICOLE MARIA FOLMER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 VILLAGE PARK WAY STE 1-S
ENCINITAS CA
92024-1994
US

IV. Provider business mailing address

1991 VILLAGE PARK WAY STE 1-S
ENCINITAS CA
92024-1994
US

V. Phone/Fax

Practice location:
  • Phone: 760-487-8063
  • Fax:
Mailing address:
  • Phone: 760-487-8063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number123560
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: