Healthcare Provider Details

I. General information

NPI: 1720648975
Provider Name (Legal Business Name): NICOLE MARIE MILLER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE DICKMAN LPC

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 GRAPHICS WAY STE 3100
LEWIS CENTER OH
43035-1123
US

IV. Provider business mailing address

1565 BETHEL RD STE 200
COLUMBUS OH
43220-2005
US

V. Phone/Fax

Practice location:
  • Phone: 740-428-0428
  • Fax: 740-909-4077
Mailing address:
  • Phone: 614-459-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.1801491
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2202994
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: