Healthcare Provider Details

I. General information

NPI: 1306284807
Provider Name (Legal Business Name): NICOLE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10151 DORRELL LN UNIT 1167
LAS VEGAS NV
89166-1026
US

IV. Provider business mailing address

10151 DORRELL LN UNIT 1167
LAS VEGAS NV
89166-1026
US

V. Phone/Fax

Practice location:
  • Phone: 850-313-0112
  • Fax:
Mailing address:
  • Phone: 850-313-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number5024
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number51023
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: