Provider Demographics
NPI:1588738819
Name:DIONNE, NICOLE M (MA, LCMHC, BCBA)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:M
Last Name:DIONNE
Suffix:
Gender:F
Credentials:MA, LCMHC, BCBA
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 563
Mailing Address - Street 2:
Mailing Address - City:ROLLINSFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03869-0563
Mailing Address - Country:US
Mailing Address - Phone:207-251-0948
Mailing Address - Fax:
Practice Address - Street 1:449 PORTSMOUTH AVE
Practice Address - Street 2:
Practice Address - City:GREENLAND
Practice Address - State:NH
Practice Address - Zip Code:03840-2221
Practice Address - Country:US
Practice Address - Phone:617-580-2706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-22-60694103K00000X
NH790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH99003227Medicaid