=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477263200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICOLE THOLMER, LPC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2022
-----------------------------------------------------
Last Update Date | 02/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 CUMBERLAND GATE SE
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-7705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-765-1652
-----------------------------------------------------
Fax | 678-426-8464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3316A S COBB DR SE STE 221
-----------------------------------------------------
City | SMYRNA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30080-4118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-765-1652
-----------------------------------------------------
Fax | 678-426-8464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/ THERAPIST
-----------------------------------------------------
Name | NICOLE THOLMER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 770-765-1652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------