Provider Demographics
NPI:1063110427
Name:RAWLINSON, NICOLE RENEE (16274-RAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:RAWLINSON
Suffix:
Gender:F
Credentials:16274-RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 CORY CT
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-5525
Mailing Address - Country:US
Mailing Address - Phone:805-264-3995
Mailing Address - Fax:
Practice Address - Street 1:401 W MORRISON AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-6124
Practice Address - Country:US
Practice Address - Phone:805-347-3338
Practice Address - Fax:866-729-9741
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16274-RAC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)