Provider Demographics
NPI:1639591852
Name:SUBLETTE, NICOLE (LCMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SUBLETTE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SUBLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LCMHC
Mailing Address - Street 1:66 HANOVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-2230
Mailing Address - Country:US
Mailing Address - Phone:603-787-3140
Mailing Address - Fax:
Practice Address - Street 1:66 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-2230
Practice Address - Country:US
Practice Address - Phone:603-787-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-07
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NH2067101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health