Healthcare Provider Details

I. General information

NPI: 1700496569
Provider Name (Legal Business Name): NICOLE KRISTINA DOZSA LCSW, LCADCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 PARK PLAZA AVE UNIT 104
LOUISVILLE KY
40241-2289
US

IV. Provider business mailing address

720 W BROADWAY STE 202
LOUISVILLE KY
40202-3245
US

V. Phone/Fax

Practice location:
  • Phone: 502-938-0511
  • Fax: 502-371-6110
Mailing address:
  • Phone: 502-561-0943
  • Fax: 502-561-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number263297
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255389
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: