Provider Demographics
NPI:1588055016
Name:GULOWSEN, NICHOLE E (LCSW, CADC, CCS)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:E
Last Name:GULOWSEN
Suffix:
Gender:F
Credentials:LCSW, CADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:ME
Mailing Address - Zip Code:04408-0095
Mailing Address - Country:US
Mailing Address - Phone:207-370-9397
Mailing Address - Fax:802-332-3142
Practice Address - Street 1:2821 MARIAVILLE RD
Practice Address - Street 2:
Practice Address - City:MARIAVILLE
Practice Address - State:ME
Practice Address - Zip Code:04605-7205
Practice Address - Country:US
Practice Address - Phone:207-370-9397
Practice Address - Fax:802-332-3142
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC16682101Y00000X, 101YM0800X, 1041C0700X
MECAC5676101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health