Provider Demographics
NPI:1386080620
Name:HUGHES, NICOLE R (LISW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW
Mailing Address - Street 1:14107 SKYLINE RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-2333
Mailing Address - Country:US
Mailing Address - Phone:505-315-3001
Mailing Address - Fax:
Practice Address - Street 1:2601 WYOMING BLVD NE
Practice Address - Street 2:STE 101
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1000
Practice Address - Country:US
Practice Address - Phone:505-315-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-052301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical