Individual
NICOLE MARIE DIERCKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
950 OLD MACK RD, CLARKSVILLE, TN 37040-8338
(512) 887-2862
Mailing address
950 OLD MACK RD, CLARKSVILLE, TN 37040-8338
(512) 887-2862
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701008933
VA
101YA0400X
Addiction (Substance Use Disorder) Counselor
16382-132
WI
101YM0800X
Mental Health Counselor
Primary
6995-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295228120
—
WI
05
—
14378296
—
VA
Enumeration date
08/28/2016
Last updated
04/01/2025
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