Provider Demographics
NPI:1164854998
Name:AYRES, NICHOLE KRISTINA (LICSW, LMHC)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:KRISTINA
Last Name:AYRES
Suffix:
Gender:F
Credentials:LICSW, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6103 MOUNT TACOMA DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2727
Mailing Address - Country:US
Mailing Address - Phone:253-215-7070
Mailing Address - Fax:253-584-1923
Practice Address - Street 1:6103 MOUNT TACOMA DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2727
Practice Address - Country:US
Practice Address - Phone:253-215-7070
Practice Address - Fax:253-584-1923
Is Sole Proprietor?:No
Enumeration Date:2013-08-03
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health