Healthcare Provider Details

I. General information

NPI: 1962101444
Provider Name (Legal Business Name): COURTNEY NIKILA DULA MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKI DULA MSW, LCSW

II. Dates (important events)

Enumeration Date: 02/23/2023
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 E MAIN ST STE 227
PLAINFIELD IN
46168-2830
US

IV. Provider business mailing address

2680 E MAIN ST STE 227
PLAINFIELD IN
46168-2830
US

V. Phone/Fax

Practice location:
  • Phone: 804-832-6389
  • Fax:
Mailing address:
  • Phone: 765-787-1196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009897A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: