Provider Demographics
NPI:1124545652
Name:BROWN, NIKKOLE MICHELLE (LMFT)
Entity type:Individual
Prefix:
First Name:NIKKOLE
Middle Name:MICHELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GEORGETOWN DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5724
Mailing Address - Country:US
Mailing Address - Phone:707-641-3100
Mailing Address - Fax:
Practice Address - Street 1:9075 ELK GROVE BLVD # 220A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2070
Practice Address - Country:US
Practice Address - Phone:916-686-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT120603106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist