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General NPI Number Information
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NPI Number | 1144557455
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Entity Type | Organization
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Legal Business Name | PEACEMAKING OF THE HUMAN SPIRIT
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 11/06/2009
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Provider Practice Location Address
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Address Line | 5608 PGA BLVD STE 206
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-4121
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Country | US
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Telephone | 561-776-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 524 PARK AVE
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City | LAKE PARK
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State | FL
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Zip | 33403-2604
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Country | US
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Telephone | 561-512-8563
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NINA NICHOLAS
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Credential | PH.D.
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Telephone | 561-776-1660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | MH7368
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License Number State | FL
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