Provider Demographics
NPI:1063779676
Name:NITSCHKE, NICHOLE LIN (LPCC)
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:LIN
Last Name:NITSCHKE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43469-1140
Mailing Address - Country:US
Mailing Address - Phone:419-848-2414
Mailing Address - Fax:567-342-5541
Practice Address - Street 1:421 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469-1140
Practice Address - Country:US
Practice Address - Phone:419-849-2414
Practice Address - Fax:567-342-5541
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE. 0007962101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional