NICOLE MARIE DIERCKS LPC CSAC CCTP-II NPI 1841746146

NPI Information

NPI: 1841746146
Provider Name: NICOLE MARIE DIERCKS, LPC, CSAC, CCTP-II
Classification: Counselor - 101Y00000X
Entity Type: Individual
Address:
7969 ASHTON AVE
MANASSAS, VA
ZIP 20109
Phone: (703) 792-4175
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Nicole Marie Diercks, LPC, CSAC, CCTP-II is a counselor in Manassas, VA. The provider is 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. Nicole Marie Diercks, LPC, CSAC, CCTP-II NPI is 1841746146. The provider is registered as an individual entity type and is a multi-specialty group.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

7969 ASHTON AVE
MANASSAS, VA
ZIP 20109-885
Phone: (703) 792-4175
Fax: (703) 792-7817

The enumeration date for this NPI number is 8/28/2016 and was last updated on 8/17/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor		0701008933	VIRGINIA	Yes
2	101Y00000X	Counselor		0710103493	VIRGINIA	No
3	101YA0400X	Counselor	Addiction (Substance Use Disorder)	6995-125	WISCONSIN	No
4	101YM0800X	Counselor	Mental Health	6995-125	WISCONSIN	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1295228120	MEDICAID	WISCONSIN
2	14378296	MEDICAID	VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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