Basic Information
| Provider Information | |||||||||
| NPI: | 1821513532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIA | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ASHLEY | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14500 ROSCOE BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007648981 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 18250 ROSCOE BLVD STE 120 | ||||||||
| Address2: | |||||||||
| City: | NORTHRIDGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913254265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242842440 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2017 | ||||||||
| LastUpdateDate: | 08/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW79034 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 104100000X | ASW79034 | CA | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | 105626 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.