Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1994 | GA |
Y | 101YP2500X | Professional Counselor | LPC008434 | |
N | 225C00000X | Rehabilitation Counselor | 00111394 |
NPI | 1083901334 |
---|---|
Provider Name | Mrs. Nicole Washington Gatlin |
First Address | Coolidge, GA 31738-2656 |
Second Address | Santa Maria, CA 93454-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2011 |
Last Update Date | 11/06/2015 |