MEDICARE: MRS. NICOLE S DEEMS ED.S., LMFT, LAC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1102249	SC
2	106H00000X	Marriage & Family Therapist	4518	SC

General Provider Information

NPI Number	:	1609082254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE S DEEMS ED.S., LMFT, LAC

Provider Business Mailing Address
First Line	:	306 DROOPING LEAF RD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-6880
Country	:	US
Telephone Number	:	803-600-2682
Fax Number	:

Provider Business Practice Location Address
First Line	:	311 MEETZE AVE STE H
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2625
Country	:	US
Telephone Number	:	803-470-3786
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/01/2019

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