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General NPI Number Information
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NPI Number | 1932759834
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Entity Type | Individual
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Provider Name | NICOLE ANN MCCORMICK LPC, LCADC, ACS
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Gender | Female
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 2720 S CLINTON AVE
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City | HAMILTON
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State | NJ
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Zip | 08610-5053
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Country | US
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Telephone | 609-631-4168
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Fax |
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Provider Business Mailing Address
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Address Line | 51 KINO BLVD
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City | HAMILTON
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State | NJ
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Zip | 08619-1452
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Country | US
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Telephone | 609-577-9376
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 37LC00260200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 37PC00542900
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License Number State | NJ
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