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General NPI Number Information
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NPI Number | 1467357574
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Entity Type | Organization
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Legal Business Name | NICOL'S VILLAGE VIBES, LLC
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 41 LATHAM VILLAGE LN APT 23
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City | LATHAM
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State | NY
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Zip | 12110-3235
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Country | US
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Telephone | 518-852-7841
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Fax | 518-245-0298
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Provider Business Mailing Address
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Address Line | 41 LATHAM VILLAGE LN APT 23
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City | LATHAM
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State | NY
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Zip | 12110-3235
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Country | US
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Telephone | 518-852-7841
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Fax | 518-245-0298
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | NICOL JENKINS
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Credential | LCSW-R
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Telephone | 518-852-7841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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