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General NPI Number Information
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NPI Number | 1952122111
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Entity Type | Individual
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Provider Name | NICOLA MANNETTER LMHCA
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Gender | Female
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 4005 N COOK ST
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City | SPOKANE
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State | WA
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Zip | 99207-5879
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Country | US
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Telephone | 509-530-4230
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Fax | 509-530-4235
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Provider Business Mailing Address
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Address Line | 110 E 27TH AVE
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City | SPOKANE
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State | WA
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Zip | 99203-2432
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Country | US
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Telephone | 208-794-6570
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC61510076
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License Number State | WA
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