Healthcare Provider Details

I. General information

NPI: 1710593249
Provider Name (Legal Business Name): NICHOLE RANDALL JUDD LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

IV. Provider business mailing address

10451 MILL RUN CIR STE 400
OWINGS MILLS MD
21117-5594
US

V. Phone/Fax

Practice location:
  • Phone: 443-583-4142
  • Fax:
Mailing address:
  • Phone: 443-583-4142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10660
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC10660
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: