Provider Demographics
NPI:1588383772
Name:DOLLICK, NICOLE DAMIAN (CADPT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DAMIAN
Last Name:DOLLICK
Suffix:
Gender:F
Credentials:CADPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4161 MARLBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1412
Mailing Address - Country:US
Mailing Address - Phone:619-282-7274
Mailing Address - Fax:
Practice Address - Street 1:4161 MARLBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1412
Practice Address - Country:US
Practice Address - Phone:619-282-7274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)