MEDICARE: NICOLE HOLCOMB COUNSELOR

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	5479	LA

General Provider Information

NPI Number	:	1811676406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE HOLCOMB COUNSELOR

Provider Business Mailing Address
First Line	:	PO BOX 73681
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70033-3681
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 FRANKLIN AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70117-7603
Country	:	US
Telephone Number	:	504-947-7949
Fax Number	:

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

Provider Enumeration Date	:	07/12/2023
Last Update Date	:	07/12/2023

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