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General NPI Number Information
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NPI Number | 1821747825
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Entity Type | Individual
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Provider Name | ABBIE NICOLE MEDICUS LPC
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Gender | Female
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Dates
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Enumeration Date | 03/18/2022
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 100 STONEFOREST DR STE 230
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City | WOODSTOCK
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State | GA
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Zip | 30189-4903
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Country | US
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Telephone | 470-552-8470
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC016046
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License Number State | GA
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