Provider Demographics
NPI:1215501697
Name:DAINO, NICOLE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:DAINO
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:GREGORIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:8540 VERREE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-1399
Mailing Address - Country:US
Mailing Address - Phone:215-342-7600
Mailing Address - Fax:
Practice Address - Street 1:2635 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4508
Practice Address - Country:US
Practice Address - Phone:215-852-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA348313101YM0800X
PAPC009666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health