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General NPI Number Information
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NPI Number | 1285528810
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Entity Type | Individual
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Provider Name | NICOLETTE R FABICK PLPC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 50 CRESTWOOD EXECUTIVE CTR STE 500
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City | SAINT LOUIS
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State | MO
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Zip | 63126-1948
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Country | US
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Telephone | 314-329-5374
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Fax |
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Provider Business Mailing Address
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Address Line | 108 PARK AVE
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City | KIRKWOOD
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State | MO
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Zip | 63122-4514
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Country | US
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Telephone | 314-578-3817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2025013018
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License Number State | MO
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