MEDICARE: MS. NICOLE DEAVER LPC, LMHC

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	101Y00000X	Counselor	8368	NC
2	101YM0800X	Mental Health Counselor	MH14265	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1740471226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICOLE DEAVER LPC, LMHC

Provider Business Mailing Address
First Line	:	201 INLAND SEAS BLVD
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-2504
Country	:	US
Telephone Number	:	828-545-0699
Fax Number	:	828-333-4320

Provider Business Practice Location Address
First Line	:	33 S MAIN ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-3124
Country	:	US
Telephone Number	:	828-545-0699
Fax Number	:	828-333-4320

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

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	12/15/2016

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