Individual
NICOLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LPC
Contact information
Practice address
404 THAMES ST FL 3, GROTON, CT 06340-3959
(860) 245-9240
Mailing address
292 S FRONTAGE RD # 1042, NEW LONDON, CT 06320-2641
(860) 245-9240
(860) 650-1125
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
Primary
5942
CT
101YP2500X
Professional Counselor
—
—
Other
Enumeration date
02/07/2020
Last updated
04/24/2024
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