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General NPI Number Information
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NPI Number | 1609490788
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Entity Type | Organization
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Legal Business Name | NICOLA CLARKE WALLEN LLC
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Dates
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Enumeration Date | 06/03/2020
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 301-960-8930
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Fax |
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Provider Business Mailing Address
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Address Line | 3261 OLD WASHINGTON RD STE 2020
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City | WALDORF
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State | MD
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Zip | 20602-3231
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Country | US
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Telephone | 301-960-8930
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NP/OWNER
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Name | NICOLA CLARKE WALLEN
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Credential | PMHNP
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Telephone | 301-960-8930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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