Provider Demographics
NPI:1902297856
Name:CAMACHO, NICOLETTE (MA)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 TATOOSH PL
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1444
Mailing Address - Country:US
Mailing Address - Phone:253-583-6235
Mailing Address - Fax:253-581-0552
Practice Address - Street 1:100 TATOOSH PL
Practice Address - Street 2:
Practice Address - City:STEILACOOM
Practice Address - State:WA
Practice Address - Zip Code:98388-1444
Practice Address - Country:US
Practice Address - Phone:253-583-6235
Practice Address - Fax:253-581-0552
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60475834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health