Healthcare Provider Details

I. General information

NPI: 1609246354
Provider Name (Legal Business Name): MICHELLE NICOPOLIS PHD, PCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 04/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL RD SUITE #200
STRONGSVILLE OH
44136
US

IV. Provider business mailing address

11565 PEARL RD SUITE 200
STRONGSVILLE OH
44136-3356
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8462
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7259
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: