Individual
NICOLE LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
67 CORPORATE DR, PORTSMOUTH, NH 03801-2847
(603) 610-8050
Mailing address
PO BOX 412503, BOSTON, MA 02241-2503
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
5025
NH
Other
Enumeration date
03/25/2021
Last updated
07/26/2024
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