| Doctor Name: | NICKOLE R VISAN |
| NPI Number: | 1447590351 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 18514 Pentecostal St Ellendale, DE - 199413358 |
| Business Phone Number: | 3024248080 |
| Business Fax Number: | |
| Mailing Address: | 18514 Pentecostal St, ELLENDALE |
| State: | DE |
| Postal Code: | 199413358 |
| Phone Number: | 3024248080 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2013 |
| NPI Last Update Date: | 03/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |