Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicole Domine, LICSW

Individual provider Clinical Social Worker · NPI 1396280954

Nicole Domine, LICSW is a Clinical Social Worker in Fargo, North Dakota. Licensed in Minnesota and North Dakota. Registered with an NPI since 2017.

Licensed in
MN, ND
In the registry since
2017
Specialties on file
2
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

4357 13th Ave S Ste 104
Fargo, ND 58103-7504
Phone: (701) 478-4480
Fax: (701) 478-4481
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 5293 (ND)
Clinical Social Worker Taxonomy 1041C0700X · Licence 23025 (MN)

Record details

NPI number1396280954
Entity typeIndividual (Type 1)
GenderFemale
Credentials LICSW
Sole proprietorNo
NPI enumeratedJanuary 5, 2017
Last updated in NPPESNovember 22, 2024
Certification dateNovember 22, 2024

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