Healthcare Provider Details

I. General information

NPI: 1164232948
Provider Name (Legal Business Name): NICOLE ZUKOWSKI MS, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 ASHWOOD DR STE 1201
CANONSBURG PA
15317-4982
US

IV. Provider business mailing address

1200 ASHWOOD DR STE 1201
CANONSBURG PA
15317-4982
US

V. Phone/Fax

Practice location:
  • Phone: 724-884-0466
  • Fax:
Mailing address:
  • Phone: 724-884-0466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC000410
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: