Provider Demographics
NPI:1861893562
Name:CUPP-HERRING, NICOLE A (LPC, LISAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:A
Last Name:CUPP-HERRING
Suffix:
Gender:F
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:A
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LISAC
Mailing Address - Street 1:202 E. EARLL DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2647
Mailing Address - Country:US
Mailing Address - Phone:602-808-2800
Mailing Address - Fax:602-599-5711
Practice Address - Street 1:202 E. EARLL DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2647
Practice Address - Country:US
Practice Address - Phone:602-599-5501
Practice Address - Fax:602-599-5711
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11079101YA0400X
AZLPC-12383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)