Healthcare Provider Details

I. General information

NPI: 1689578247
Provider Name (Legal Business Name): NICONIA HORACE MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6445 LYNDALE AVE S APT 439
MINNEAPOLIS MN
55423-7567
US

IV. Provider business mailing address

6445 LYNDALE AVE S APT 439
MINNEAPOLIS MN
55423-7567
US

V. Phone/Fax

Practice location:
  • Phone: 404-980-0804
  • Fax:
Mailing address:
  • Phone: 404-980-0804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC05746
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: