Provider Demographics
NPI:1962902437
Name:PALACIOS, NICOLE ISABELL
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ISABELL
Last Name:PALACIOS
Suffix:
Gender:F
Credentials:
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 2653
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2653
Mailing Address - Country:US
Mailing Address - Phone:907-531-6047
Mailing Address - Fax:
Practice Address - Street 1:133 SMITH WAY UNIT C
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8077
Practice Address - Country:US
Practice Address - Phone:907-531-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001301101YA0400X
COCSW.099262161041C0700X
AK1542201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)