Healthcare Provider Details

I. General information

NPI: 1568479491
Provider Name (Legal Business Name): MONICA ANNE NICOLL LCMHC, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 WHITE MOUNTAIN HIGHWAY
NORTH CONWAY NH
03860-1435
US

IV. Provider business mailing address

PO BOX 1435
NORTH CONWAY NH
03860-1435
US

V. Phone/Fax

Practice location:
  • Phone: 603-901-2454
  • Fax:
Mailing address:
  • Phone: 603-901-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberNH1170
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: