Individual
NICKOLE BUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 QUARTZ DR STE 103A, VILLA RICA, GA 30180-3201
(678) 471-6925
Mailing address
101 QUARTZ DR STE 103A, VILLA RICA, GA 30180-3201
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
APC006745
GA
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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