Healthcare Provider Details

I. General information

NPI: 1588738819
Provider Name (Legal Business Name): NICOLE M. DIONNE MA, LCMHC, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 PORTSMOUTH AVE
GREENLAND NH
03840-2221
US

IV. Provider business mailing address

PO BOX 563
ROLLINSFORD NH
03869-0563
US

V. Phone/Fax

Practice location:
  • Phone: 617-580-2706
  • Fax:
Mailing address:
  • Phone: 207-251-0948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-60694
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number790
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: