Provider Information for 1356886204
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NICOLE NONCLERC MS, LMHC, MCAP, NCC
Other Names:Former Name:NICOLE BRENNEMANSex: Female
NPI: 1356886204
Last Updated: 2021-02-08
Certification Date: 2021-01-22
Certification Date: 2021-01-22
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1356886204 | ||||||||||||
| Enumeration Date | 2017-01-02 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 1850 PROVIDENCE LAKES BLVD APT 816 BRANDON, FL 33511-1843 United States Phone: 813-376-0518 | Fax: | ||||||||||||
| Primary Practice Address | 1134 BELL SHOALD ROAD BRANDON, FL 33511 United States Phone: 813-315-8648 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 1001 E BAKER ST | ||||||||||||
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