Provider Demographics
NPI:1528422458
Name:DAWKINS, NICHOLE (RIMHC)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:RIMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S ORLANDO AVE STE E
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6471
Mailing Address - Country:US
Mailing Address - Phone:407-860-0639
Mailing Address - Fax:407-505-6373
Practice Address - Street 1:1515 S ORLANDO AVE STE E
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6471
Practice Address - Country:US
Practice Address - Phone:407-603-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24598101YM0800X, 103K00000X, 106E00000X, 106S00000X
FLPMT220106H00000X
372600000X, 374U00000X, 376J00000X
FLCBHCMS.0102720171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL121438400Medicaid
FL688263396Medicaid