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 1:4088 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4422
Mailing Address - Country:US
Mailing Address - Phone:843-670-7813
Mailing Address - Fax:
Practice Address - Street 1:3044 SHALLOWFORD RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3641
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:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC005927101YM0800X
GALPC011879101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health