Individual
NICOLE FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMHC, NCC
Contact information
Practice address
5440 LAWRENCEVILLE HWY NW, LILBURN, GA 30047-5927
(678) 802-9355
(678) 802-9355
Mailing address
3228 WAKEFIELD ST, LAWRENCEVILLE, GA 30044-5677
(404) 313-9962
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
LPC004808
GA
101YM0800X
Mental Health Counselor
MH7359
FL
Other
Enumeration date
10/03/2017
Last updated
10/03/2017
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