Provider Demographics
NPI:1487102711
Name:LOW, NICHOLE RAE (CADC II, MRT-DV)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:RAE
Last Name:LOW
Suffix:
Gender:F
Credentials:CADC II, MRT-DV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 SW 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2135
Mailing Address - Country:US
Mailing Address - Phone:541-709-3059
Mailing Address - Fax:541-719-1709
Practice Address - Street 1:279 SW 10TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2135
Practice Address - Country:US
Practice Address - Phone:541-709-3059
Practice Address - Fax:541-719-1709
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)