Provider Demographics
NPI:1619715307
Name:STOTT, NICHOLAS WILLIAM
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:WILLIAM
Last Name:STOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4553 WATKINS ST
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-2511
Mailing Address - Country:US
Mailing Address - Phone:877-763-0376
Mailing Address - Fax:850-994-4080
Practice Address - Street 1:4553 WATKINS ST
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-2511
Practice Address - Country:US
Practice Address - Phone:877-763-0376
Practice Address - Fax:850-994-4080
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)