Healthcare Provider Details

I. General information

NPI: 1497364731
Provider Name (Legal Business Name): MICKAYLA NERO LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICKAYLA WALDHAUSER LCPC

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 DALE AVE
BALTIMORE MD
21206-1305
US

IV. Provider business mailing address

604 DALE AVE
BALTIMORE MD
21206-1305
US

V. Phone/Fax

Practice location:
  • Phone: 443-267-2431
  • Fax:
Mailing address:
  • Phone: 443-267-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC16004
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: