Individual
NICOLE E BALICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 STONY LANDING RD, MONCKS CORNER, SC 29461-3967
(413) 418-2300
Mailing address
403 STONY LANDING RD, MONCKS CORNER, SC 29461-3967
(843) 761-8282
(843) 761-7308
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1303295
—
MA
05
—
1307576
—
MA
01
—
M18463
BLUE CROSS/BLUE SHIELD
—
Enumeration date
07/02/2012
Last updated
06/28/2018
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