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General NPI Number Information
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NPI Number | 1700496569
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Entity Type | Individual
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Provider Name | NICOLE KRISTINA DOZSA LCSW, LCADCA
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Gender | Female
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 9720 PARK PLAZA AVE UNIT 104
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City | LOUISVILLE
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State | KY
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Zip | 40241-2289
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Country | US
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Telephone | 502-938-0511
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Fax | 502-371-6110
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Provider Business Mailing Address
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Address Line | 720 W BROADWAY STE 202
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City | LOUISVILLE
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State | KY
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Zip | 40202-3245
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Country | US
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Telephone | 502-561-0943
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Fax | 502-561-0944
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 263297
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 255389
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License Number State | KY
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