Provider Demographics
NPI:1689033003
Name:KOUMARIANOS, NICHOLAS (LPC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KOUMARIANOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 BONAIRE DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-3846
Mailing Address - Country:US
Mailing Address - Phone:732-703-8008
Mailing Address - Fax:
Practice Address - Street 1:255 BONAIRE DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08757-3846
Practice Address - Country:US
Practice Address - Phone:732-703-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-12
Last Update Date:2024-05-09
Deactivation Date:2024-04-23
Deactivation Code:
Reactivation Date:2024-05-09
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ37PC01029600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health