Provider Demographics
NPI:1871094565
Name:DURANT, NICOLE LOUISE (LPCC-S)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOUISE
Last Name:DURANT
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LOUISE
Other - Last Name:DURBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCC-S
Mailing Address - Street 1:3575 FOREST LAKE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8115
Mailing Address - Country:US
Mailing Address - Phone:330-703-0105
Mailing Address - Fax:
Practice Address - Street 1:3575 FOREST LAKE DR STE 100
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8115
Practice Address - Country:US
Practice Address - Phone:330-703-0105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OHE.2001732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307253Medicaid