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General NPI Number Information
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NPI Number | 1053868489
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Entity Type | Individual
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Provider Name | NICOLE JOOSTEN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 5235 KING AVE STE 200
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City | ROSEDALE
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State | MD
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Zip | 21237-4073
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Country | US
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Telephone | 410-210-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 5235 KING AVE STE 200
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City | ROSEDALE
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State | MD
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Zip | 21237-4073
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Country | US
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Telephone | 518-461-8073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810007762
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001641
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC006250
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License Number State | GA
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