Annette Lickwola, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

44.001570 Issued in CT

Practice address

931 Bank St
New London, CT 06320-2702

Phone

(860) 574-8256

NPI assigned

Jun 11, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1093557050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "931 BANK ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063202702",
            "telephone_number": "860-574-8256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "931 BANK ST",
            "city": "NEW LONDON",
            "state": "CT",
            "postal_code": "063202702",
            "telephone_number": "860-574-8256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LICKWOLA",
        "first_name": "ANNETTE",
        "name_prefix": "Mrs.",
        "credential": "LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "44.001570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madena Lynn Lewis, APRN
• Tiara R Lewis, BA
• Karen Jiaqi Li, NP-BC
• Lisa A Licare, D.O.
• Paul J Licata, D.O.
• Priscilla Liebenthal, LMFT
• Elizabeth Ligon
• Melissa Lin Monte, DO
• Nicholas Lind, PHARMD
• Jamila Linder

• Addiction (Substance Use Disorder) Counselor in New London, CT
• Providers in New London, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.