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General NPI Number Information
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NPI Number | 1144324567
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Entity Type | Individual
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Provider Name | NIKOLE SMALLS JONES LICSW
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Gender | Female
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Dates
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Enumeration Date | 09/08/2006
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER C/O MENTAL HEALTH SERVICE LINE #116 AVE D. BUILDING 364
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City | PERRYVILLE
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State | MD
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Zip | 21902
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Country | US
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Telephone | 410-642-2411
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Fax | 410-642-1707
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Provider Business Mailing Address
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Address Line | VA MEDICAL CENTER C/O MENTAL HEALTH SERVICE LINE #116 PERRY POINT VA MEDICAL CENTER AVE D. BUILDING 364
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City | PERRYVILLE
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State | MD
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Zip | 21902
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Country | US
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Telephone | 410-642-2411
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Fax | 410-642-1707
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50078117
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 17753
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License Number State | MD
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