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General NPI Number Information
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NPI Number | 1740471226
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Entity Type | Individual
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Provider Name | NICOLE DEAVER LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/08/2007
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Last Update Date | 12/15/2016
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Provider Practice Location Address
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Address Line | 33 S MAIN ST
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City | WINTER GARDEN
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State | FL
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Zip | 34787-3124
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Country | US
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Telephone | 828-545-0699
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Fax | 828-333-4320
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Provider Business Mailing Address
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Address Line | 201 INLAND SEAS BLVD
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City | WINTER GARDEN
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State | FL
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Zip | 34787-2504
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Country | US
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Telephone | 828-545-0699
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Fax | 828-333-4320
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 8368
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License Number State | NC
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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 | MH14265
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License Number State | FL
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