Provider Demographics
NPI:1366618365
Name:NICOLES, ANDREA MICHELLE (MSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MICHELLE
Last Name:NICOLES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 N PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-2125
Mailing Address - Country:US
Mailing Address - Phone:574-727-0333
Mailing Address - Fax:
Practice Address - Street 1:3228 N PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-2125
Practice Address - Country:US
Practice Address - Phone:574-727-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006885A104100000X
101Y00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator