Doctor Name: | MRS. DEBORAH LYNN NICKENS |
NPI Number: | 1467711838 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S, LMHC |
License Number: | MH11221 |
Business Practice Address: | 810 Hollywood Blvd W Melbourne, FL - 329047418 |
Business Phone Number: | 3215064625 |
Business Fax Number: | 3217238233 |
Mailing Address: | Po Box 120729, W MELBOURNE |
State: | FL |
Postal Code: | 329120729 |
Phone Number: | 3215064625 |
Fax Number: | 3217238233 |
NPI Enumeration Date: | 05/04/2012 |
NPI Last Update Date: | 05/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH11221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |