Individual
NICOLE STACKPOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, R-DMT
Contact information
Practice address
112 CIMARRON PARK LOOP STE B, BUDA, TX 78610-2850
(512) 643-0840
Mailing address
2915 AFTONSHIRE WAY APT 9301, AUSTIN, TX 78748-5883
(512) 643-0840
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
79813
TX
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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