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General NPI Number Information
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NPI Number | 1184038440
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Entity Type | Individual
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Provider Name | NICOLE MCNISH LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 10/21/2016
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Provider Practice Location Address
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Address Line | 9300 DEWITT LOOP FORT BELVOIR COMMUNITY HOSPITAL
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City | FORT BELVOIR
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State | VA
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Zip | 22060
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Country | US
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Telephone | 571-231-1235
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Fax |
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Provider Business Mailing Address
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Address Line | 6042 KNIGHTS RIDGE WAY
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1636
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Country | US
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Telephone | 240-505-6962
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12343
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License Number State | TX
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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 | C008275
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License Number State | NC
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