Healthcare Provider Details

I. General information

NPI: 1932371069
Provider Name (Legal Business Name): MS. NICOLE VANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 K ST NW STE 405
WASHINGTON DC
20001-4425
US

IV. Provider business mailing address

1003 K ST NW STE 405
WASHINGTON DC
20001-4425
US

V. Phone/Fax

Practice location:
  • Phone: 202-628-8848
  • Fax: 202-628-8849
Mailing address:
  • Phone: 202-628-8848
  • Fax: 202-628-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC13879
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: