Healthcare Provider Details

I. General information

NPI: 1477263200
Provider Name (Legal Business Name): NICOLE THOLMER, LPC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2022
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CUMBERLAND GATE SE
SMYRNA GA
30080-7705
US

IV. Provider business mailing address

3316A S COBB DR SE STE 221
SMYRNA GA
30080-4118
US

V. Phone/Fax

Practice location:
  • Phone: 770-765-1652
  • Fax: 678-426-8464
Mailing address:
  • Phone: 770-765-1652
  • Fax: 678-426-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NICOLE THOLMER
Title or Position: CEO/ THERAPIST
Credential: LPC
Phone: 770-765-1652