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General NPI Number Information
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NPI Number | 1588738819
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Entity Type | Individual
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Provider Name | NICOLE M. DIONNE MA, LCMHC, BCBA
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 449 PORTSMOUTH AVE
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City | GREENLAND
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State | NH
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Zip | 03840-2221
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Country | US
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Telephone | 617-580-2706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 563
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City | ROLLINSFORD
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State | NH
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Zip | 03869-0563
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Country | US
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Telephone | 207-251-0948
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-22-60694
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 790
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License Number State | NH
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