| Doctor Name: | NICOLE DRAKE |
| NPI Number: | 1407257785 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, LCADC, ACS |
| License Number: | 37LC00157100 |
| Business Practice Address: | 36 Green Grove Ave #2 Keyport, NJ - 077351839 |
| Business Phone Number: | 9086935279 |
| Business Fax Number: | |
| Mailing Address: | 36 Green Grove Ave, #2 KEYPORT |
| State: | NJ |
| Postal Code: | 077351839 |
| Phone Number: | 9086935279 |
| Fax Number: | |
| NPI Enumeration Date: | 09/05/2014 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00157100 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |