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Individual

NICOLE DANIELLE WALLICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LSW, LAC

Contact information

Practice address
2194 N POINTE DR, WARSAW, IN 46582-9043
(574) 218-6711
Mailing address
4309 S PACKERTON RD, WARSAW, IN 46580-8714
(574) 269-7479

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
86000019A
IN

Other

Enumeration date
04/14/2020
Last updated
04/14/2020
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