Provider Demographics
NPI:1679939805
Name:NUCKOLS-HORTON, NAKISHA
Entity type:Individual
Prefix:
First Name:NAKISHA
Middle Name:
Last Name:NUCKOLS-HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NAKISHA
Other - Middle Name:
Other - Last Name:NUCKOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 FLORIN RD APT 122
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-2093
Mailing Address - Country:US
Mailing Address - Phone:916-634-5657
Mailing Address - Fax:
Practice Address - Street 1:7171 BOWLING DR STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2043
Practice Address - Country:US
Practice Address - Phone:916-634-5657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X, 372600000X
NV101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health