Healthcare Provider Details

I. General information

NPI: 1316340920
Provider Name (Legal Business Name): NICOLE D. MORGAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8134 OLD KEENE MILL RD SUITE 101
SPRINGFIELD VA
22152-1800
US

IV. Provider business mailing address

754 WARRENTON RD SUITE 113-229
FREDERICKSBURG VA
22406-1098
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8736
  • Fax: 703-569-7248
Mailing address:
  • Phone: 540-395-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005080
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: