Healthcare Provider Details

I. General information

NPI: 1629382288
Provider Name (Legal Business Name): NICHELLE VANESSA PATTERSON M.S., LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 KIRK AVE
BALTIMORE MD
21218-5507
US

IV. Provider business mailing address

427 CHARTLEY PARK RD
REISTERSTOWN MD
21136-2003
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax:
Mailing address:
  • Phone: 443-257-8967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4983
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: