Nicole M Costell

Primary specialty

Social WorkerTaxonomy code 104100000X

License

SW18360 Issued in FL

Practice address

6600 Van Aalst Blvd BLDG 9250
Fort Moore, GA 31905-2102

Phone

(850) 885-9972

NPI assigned

Jun 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1496620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708473600000",
    "number": "1982133864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD BLDG 9250",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD BLDG 9250",
            "city": "FORT MOORE",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "850-885-9972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTELL",
        "first_name": "NICOLE",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-05",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW77761",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW18360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas Chaput, PA-C
• Robynn Latise Chavez, LCSW
• Celina Chung, MSPT
• Rebecca Ann Clark, PH.D, LCSW
• Robert Charlton Cooper, OTR/L
• Jeremy Keith Crouch, CRNA
• Deana Cruz
• Cindy Rosemarie Dad, MSW, LCSW, LAC
• Olasumbo Oluwakemi Dada
• Jessica Laurel Dawson, LCSW

• Social Worker in Fort Moore, GA
• Providers in Fort Moore, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.