Individual
NICOLE M COSTELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
(850) 885-9972
Mailing address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
ASW77761
CA
104100000X
Social Worker
Primary
SW18360
FL
Other
Enumeration date
06/05/2017
Last updated
02/21/2024
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