Doctor Name: | NICOLE POLLOCK STORY |
NPI Number: | 1811225485 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ED.S, LMHC, LMFT |
License Number: | MH7433 |
Business Practice Address: | 808 3rd St Ste A Neptune Beach, FL - 322665080 |
Business Phone Number: | 9042340574 |
Business Fax Number: | |
Mailing Address: | 233 E Bay St Ste 920, JACKSONVILLE |
State: | FL |
Postal Code: | 322023434 |
Phone Number: | 9042340574 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2009 |
NPI Last Update Date: | 11/19/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH7433 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |