Provider Demographics
NPI:1225548456
Name:EUSTACE, NICOLANNE SMITH (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLANNE
Middle Name:SMITH
Last Name:EUSTACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 INDEPENDENCE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-5164
Mailing Address - Country:US
Mailing Address - Phone:843-670-7813
Mailing Address - Fax:
Practice Address - Street 1:1820 INDEPENDENCE SQ STE A
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-5164
Practice Address - Country:US
Practice Address - Phone:843-670-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005927101YM0800X
GALPC011879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health