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Nicole Marie Diercks, LPC,CSAC
Counselor in Fort Campbell, Kentucky
NPI 1841746146

Nicole Marie Diercks is a Counselor based in Woodbridge, KY. Nicole Marie Diercks practices in Fort Campbell, KY and has the professional credentials of LPC,CSAC. The NPI Number for Nicole Marie Diercks is 1841746146 and holds a License No. 16382-132 (Kentucky).

The current practice location address for Nicole Marie Diercks is 650 Joel Dr, Fort Campbell, KY and can be reached out via phone at 270-798-8727 and via fax at 270-798-8224.

Location: 650 Joel Dr, Fort Campbell, KY, 22192-5015
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1841746146
Provider Name
Nicole Marie Diercks
Credential
LPC,CSAC
Provider Entity Type
Individual
Gender
Female
Address
650 Joel Dr, Fort Campbell, KY, 22192-5015
Phone Number
270-798-8727
Fax Number
270-798-8224
Provider Enumeration Date
08/28/2016
Last Update Date
11/16/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
1295228120 05 WI
14378296 05 VA
institution
Provider Business Practice Location Address Details
Address
650 Joel Dr
City
Fort Campbell
State
Kentucky
Zip
42223-5318
Phone Number
270-798-8727
Fax Number
270-798-8224
person
Provider Business Mailing Address Details
Address
650 Joel Dr
City
Fort Campbell
State
Kentucky
Zip
42223-5318
Phone Number
270-798-8727
Fax Number
270-798-8224
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
-
Taxonomy
101Y00000X
License No.
0701008933 (Virginia)
Definition
A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master's degree and clinical experience and supervision for licensure or certification.
person
Provider's Taxonomy Details 2
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Addiction (Substance Use Disorder)
Taxonomy
101YA0400X
License No.
6995-125 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 4
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Professional
Taxonomy
101YP2500X
License No.
16382-132 (Wisconsin)
Definition
Definition to come...
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