Healthcare Provider Details

I. General information

NPI: 1700269099
Provider Name (Legal Business Name): NIKKI MCCARTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2015
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 DELTONA BLVD STE A
DELTONA FL
32725-8016
US

IV. Provider business mailing address

2518 PRESERVE CT
MULBERRY FL
33860-7541
US

V. Phone/Fax

Practice location:
  • Phone: 386-259-5413
  • Fax: 386-753-9265
Mailing address:
  • Phone: 863-934-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: