Provider Demographics
NPI:1306438403
Name:PIQUE, NICOLE ERIN
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ERIN
Last Name:PIQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2758 ARIANE DR UNIT 126
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-3412
Mailing Address - Country:US
Mailing Address - Phone:214-797-7559
Mailing Address - Fax:
Practice Address - Street 1:2701 MIDWAY DR
Practice Address - Street 2:UNIT 371141
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:904-638-6388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0-24-15352106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst