Provider Demographics
NPI:1902118797
Name:ILACQUA, NICOLE MICHELLE (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:ILACQUA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:MICHELLE
Other - Last Name:NEIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCC-S LICDC
Mailing Address - Street 1:2323 TIMBER SHADOWS DR STE B
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2323 TIMBER SHADOWS DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2028
Practice Address - Country:US
Practice Address - Phone:832-233-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69575101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional