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NPI Code Detail

MEDICARE: NICOLE QUENNEVILLE LPCC

MEDICARE: NICOLE QUENNEVILLE LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLCDCIII.141170OH
2101YP2500XProfessional CounselorLICDC.161597OH
3101YA0400XAddiction (Substance Use Disorder) CounselorE.1300209-SUPVOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447704416
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE QUENNEVILLE LPCC
Provider Business Mailing Address
First Line : 5241 MONTGOMERY ROAD
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-1655
Country : US
Telephone Number : 216-225-4464
Fax Number :
Provider Business Practice Location Address
First Line : 5241 MONTGOMERY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-1655
Country : US
Telephone Number : 513-993-5241
Fax Number : 513-586-2768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2016
Last Update Date : 06/15/2022

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Directions to “ NICOLE QUENNEVILLE LPCC” Practice Location

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