Provider Demographics
NPI:1962362079
Name:DETRICK, NICOLE M (NPI)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:DETRICK
Suffix:
Gender:F
Credentials:NPI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14252 AUTUMN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8995
Mailing Address - Country:US
Mailing Address - Phone:317-698-3384
Mailing Address - Fax:
Practice Address - Street 1:136 S 9TH ST STE 204
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2600
Practice Address - Country:US
Practice Address - Phone:317-401-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health