Provider Demographics
NPI:1174939201
Name:WILLIAMS, NICOLE (LCSW)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W. 136TH AVE.
Mailing Address - Street 2:STE 106, PMB 2882
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-9306
Mailing Address - Country:US
Mailing Address - Phone:720-316-6276
Mailing Address - Fax:
Practice Address - Street 1:9251 RUSSELL WAY
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-7632
Practice Address - Country:US
Practice Address - Phone:720-316-6276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009923025104100000X
CO.099286371041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker