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General NPI Number Information
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NPI Number | 1467102616
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Entity Type | Individual
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Provider Name | NICOLE VALDES LPC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2022
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Last Update Date | 11/26/2023
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Provider Practice Location Address
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Address Line | 300 DAVIS AVE STE 100F
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-4543
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Country | US
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Telephone | 228-382-3252
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 87
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City | PASS CHRISTIAN
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State | MS
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Zip | 39571-0087
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Country | US
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Telephone | 228-382-3252
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3045
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License Number State | MS
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