Provider Demographics
NPI:1477161016
Name:PAYNE, NICOLE CHRISTINA (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHRISTINA
Last Name:PAYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2941
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-1141
Mailing Address - Country:US
Mailing Address - Phone:323-205-5581
Mailing Address - Fax:
Practice Address - Street 1:24520 HAWTHORNE BLVD STE 220
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6848
Practice Address - Country:US
Practice Address - Phone:310-243-6153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT156310106H00000X
CAAMFT132012106H00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty