Provider Demographics
NPI:1972999043
Name:GROSS, NICOLE (NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GROSS
Suffix:
Gender:F
Credentials:NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 UPTON CIR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5885
Mailing Address - Country:US
Mailing Address - Phone:610-212-9692
Mailing Address - Fax:610-738-4970
Practice Address - Street 1:1211 UPTON CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5885
Practice Address - Country:US
Practice Address - Phone:610-212-9692
Practice Address - Fax:610-738-4970
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor