Healthcare Provider Details

I. General information

NPI: 1720710502
Provider Name (Legal Business Name): MRS. NICOLE ALDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N 6TH ST UNIT 1 #905
SAINT AUGUSTINE FL
32084-1920
US

IV. Provider business mailing address

2800 N 6TH ST
SAINT AUGUSTINE FL
32084-1920
US

V. Phone/Fax

Practice location:
  • Phone: 904-300-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701015538
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number100494
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number26083
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: