Provider Demographics
NPI:1528307956
Name:NICOLS, ADELE (MA)
Entity type:Individual
Prefix:MS
First Name:ADELE
Middle Name:
Last Name:NICOLS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:
Other - Last Name:NICOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC, LADC
Mailing Address - Street 1:144 MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-2918
Mailing Address - Country:US
Mailing Address - Phone:802-279-0562
Mailing Address - Fax:888-959-2523
Practice Address - Street 1:73 MAIN ST
Practice Address - Street 2:SUITE 36
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-2932
Practice Address - Country:US
Practice Address - Phone:802-279-0562
Practice Address - Fax:888-959-2523
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000570101YA0400X
VT068.0066934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)