Healthcare Provider Details

I. General information

NPI: 1447843982
Provider Name (Legal Business Name): NICOLETTE NICOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2021
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CONNECTICUT AVE NW STE 450
WASHINGTON DC
20036-4359
US

IV. Provider business mailing address

14420 W SIDE BLVD APT 107
LAUREL MD
20707-6268
US

V. Phone/Fax

Practice location:
  • Phone: 202-706-7603
  • Fax:
Mailing address:
  • Phone: 240-602-5706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: