Provider Demographics
NPI:1285474734
Name:FREEZE, NICOLE (LMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FREEZE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6478B 102ND ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-3345
Mailing Address - Country:US
Mailing Address - Phone:330-503-2995
Mailing Address - Fax:
Practice Address - Street 1:6478B 102ND ST
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-3345
Practice Address - Country:US
Practice Address - Phone:330-503-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC-1030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health