Healthcare Provider Details

I. General information

NPI: 1295968717
Provider Name (Legal Business Name): NICHOLE BONNIE GREGORY L.A.D.C. LICENSE ALC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE BONNIE SWANSON P.L.A.D.C. PROVISION

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 NORTH PLATTE STREET AWARENESS COUNSELING
FREMONT NE
68025-2630
US

IV. Provider business mailing address

2170 NORTH PLATTE STREET AWARENESS COUNSELING
FREMONT NE
68025-2630
US

V. Phone/Fax

Practice location:
  • Phone: 402-753-6440
  • Fax: 402-753-6445
Mailing address:
  • Phone: 402-753-6440
  • Fax: 402-753-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number857
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberP658
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: