Provider Demographics
NPI:1730511759
Name:SMITH, NICOLE REGINA (LMHC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:REGINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ROSEMARY AVE STE 204-A40
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-6313
Mailing Address - Country:US
Mailing Address - Phone:321-662-0839
Mailing Address - Fax:
Practice Address - Street 1:700 S ROSEMARY AVE STE 204-A40
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-6313
Practice Address - Country:US
Practice Address - Phone:321-662-0839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22361101YA0400X, 101YS0200X, 101YM0800X, 103TP2701X, 103TC0700X
101YA0400X, 101YM0800X
MH22361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH22361OtherFLORIDA DEPARTMENT OF HEALTH