Healthcare Provider Details

I. General information

NPI: 1811538317
Provider Name (Legal Business Name): NICOLE MCDONAGH CPC, LCADC, LCADC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MCDONAGH CPC, LCADC, LCADC-S

II. Dates (important events)

Enumeration Date: 10/05/2019
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6362 MCLEOD DR STE 6
LAS VEGAS NV
89120-4433
US

IV. Provider business mailing address

6362 MCLEOD DR STE 6
LAS VEGAS NV
89120-4433
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-1990
  • Fax: 702-831-8812
Mailing address:
  • Phone: 702-483-1990
  • Fax: 702-831-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07378-LC
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number07517LCS
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number3215-21
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP5377
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: