Healthcare Provider Details

I. General information

NPI: 1093630048
Provider Name (Legal Business Name): NICOLE LYNN THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WHITNEY DR
MILFORD OH
45150-8402
US

IV. Provider business mailing address

579 RIVERSBREEZE DR
LUDLOW KY
41016-1705
US

V. Phone/Fax

Practice location:
  • Phone: 470-489-9580
  • Fax:
Mailing address:
  • Phone: 470-489-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number196868
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: