Healthcare Provider Details

I. General information

NPI: 1568839942
Provider Name (Legal Business Name): NICOLE MARIE ERVIN MHCA.MC.70119748
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 CONTINENTAL PL
MOUNT VERNON WA
98273-5633
US

IV. Provider business mailing address

8262 BALFOUR VALLEY LN
MAPLE FALLS WA
98266-7070
US

V. Phone/Fax

Practice location:
  • Phone: 360-441-3497
  • Fax:
Mailing address:
  • Phone: 360-441-3497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHCA.MC.70119748
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO60561852
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: