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Individual
LEIGH-DEMETRA NICKLOW
Active
Individual
LEIGH-DEMETRA NICKLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCC, LADC, SC-C
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
5772
MN
390200000X
Student in an Organized Health Care Education/Training Program
Primary
306810
MN
Other
Enumeration date
10/15/2025
Last updated
09/11/2026
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