Provider Demographics
NPI:1871134478
Name:NICOLE MANK, LCSW, LLC
Entity type:Organization
Organization Name:NICOLE MANK, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-242-8359
Mailing Address - Street 1:126 WESTERN AVE # 1026
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7249
Mailing Address - Country:US
Mailing Address - Phone:207-242-8359
Mailing Address - Fax:207-560-9093
Practice Address - Street 1:126 WESTERN AVE # 1026
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7249
Practice Address - Country:US
Practice Address - Phone:207-242-8359
Practice Address - Fax:207-560-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health