Individual
NIKKI LANCLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CASAC-T
Contact information
Practice address
165 FULTON STREET, WEST BABYLON, NY 11704
(631) 258-2904
Mailing address
165 FULTON ST, WEST BABYLON, NY 11704-2037
(631) 258-2904
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
24809
NY
Other
Enumeration date
07/03/2014
Last updated
07/03/2014
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