Doctor Name: | NICHOL A BOBERG |
NPI Number: | 1730487687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MED, PCC-S |
License Number: | E.8044-SUPV |
Business Practice Address: | 400 Lakeview Dr Unit 206 Wilder, KY - 410715310 |
Business Phone Number: | 8598167475 |
Business Fax Number: | |
Mailing Address: | 400 Lakeview Dr Unit 206, WILDER |
State: | KY |
Postal Code: | 410715310 |
Phone Number: | 8598167475 |
Fax Number: | |
NPI Enumeration Date: | 03/02/2011 |
NPI Last Update Date: | 03/02/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | E.8044-SUPV |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |