Individual
NICOLE DARLENE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
2018013675
MO
101YP2500X
Professional Counselor
Primary
16030
CA
101YP2500X
Professional Counselor
37PC00899200
NJ
101YP2500X
Professional Counselor
PC-0011186
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490055189
—
MO
Enumeration date
06/06/2018
Last updated
01/05/2026
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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