Individual
NICOLE SALLY LIGHTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4700 VON KARMAN AVE STE 102, NEWPORT BEACH, CA 92660
(949) 743-1457
(949) 629-2500
Mailing address
PO BOX 26224, SANTA ANA, CA 92799-6224
(520) 400-8171
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
PSY28608
CA
Other
Enumeration date
07/14/2010
Last updated
08/30/2018
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