Individual
NICHOLE DECORAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
1508 NEW PINERY RD, PORTAGE, WI 53901-1312
(608) 745-4900
Mailing address
532 LAUREL ST, REEDSBURG, WI 53959-1231
(608) 566-5187
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5176-226
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154894848
—
WI
Enumeration date
01/06/2019
Last updated
08/21/2024
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