Healthcare Provider Details

I. General information

NPI: 1346209004
Provider Name (Legal Business Name): BONNIE NICOL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 MORGAN CIR
WETHERSFIELD CT
06109-4052
US

IV. Provider business mailing address

117 MORGAN CIR
WETHERSFIELD CT
06109-4052
US

V. Phone/Fax

Practice location:
  • Phone: 860-212-7963
  • Fax:
Mailing address:
  • Phone: 860-212-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number000515
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: