Healthcare Provider Details

I. General information

NPI: 1689145336
Provider Name (Legal Business Name): CHRISTINE NICOLELLO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE WNOROWSKI LMHC

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 REVOLUTION ST
HAVRE DE GRACE MD
21078-3320
US

IV. Provider business mailing address

204 TIMBER TRL
BEL AIR MD
21014-3172
US

V. Phone/Fax

Practice location:
  • Phone: 410-996-5104
  • Fax:
Mailing address:
  • Phone: 516-712-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC9240
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: