Doctor Name: | MS. NICOLE IVORY GOICURIA |
NPI Number: | 1003096561 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA |
License Number: | |
Business Practice Address: | 2514 N Broad St Philadelphia, PA - 191324013 |
Business Phone Number: | 2155992808 |
Business Fax Number: | 2155991041 |
Mailing Address: | 2514 N Broad St, PHILADELPHIA |
State: | PA |
Postal Code: | 191324013 |
Phone Number: | 2155992808 |
Fax Number: | 2155991041 |
NPI Enumeration Date: | 11/13/2007 |
NPI Last Update Date: | 11/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |