Nicole M Costell
Social Worker in Fort Moore, GA. Individual provider (NPI-1).
NPI number1982133864
StatusActive
Last updated in NPPESFeb 21, 2024
Details
- NPI
- 1982133864
- Entity type
- Individual (NPI-1)
- Name
- Nicole M Costell
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 5, 2017
- Certification date
- Feb 21, 2024
- Last updated
- Feb 21, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 104100000X | Social Worker | SW18360 | FL | Yes |
| 101Y00000X | Counselor | – | – | |
| 101YM0800X | Counselor, Mental Health | ASW77761 | CA |
Practice location
6600 Van Aalst Blvd Bldg 9250Fort Moore, GA 31905-2102
Phone 850-885-9972
Mailing address
6600 Van Aalst Blvd Bldg 9250Fort Moore, GA 31905-2102
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