Healthcare Provider Details

I. General information

NPI: 1790368835
Provider Name (Legal Business Name): NICOLE REPPUCCI LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 CAMINO DEL RIO S STE 201
SAN DIEGO CA
92108-3505
US

IV. Provider business mailing address

409 CAMINO DEL RIO S. SUITE 201
SAN DIEGO CA
92108-5504
US

V. Phone/Fax

Practice location:
  • Phone: 619-346-4020
  • Fax:
Mailing address:
  • Phone: 619-346-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19198
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: