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General NPI Number Information
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NPI Number | 1639744840
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Entity Type | Organization
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Legal Business Name | NICOLE BANKS
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 314 WYNDHURST AVE
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City | BALTIMORE
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State | MD
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Zip | 21210-2416
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Country | US
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Telephone | 443-914-3425
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Fax |
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Provider Business Mailing Address
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Address Line | 214 COMMODORE WAY
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City | ODENTON
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State | MD
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Zip | 21113-2607
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Country | US
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Telephone | 443-804-4924
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/OWNER
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Name | NICOLE BANKS
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Credential | LCPC
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Telephone | 443-914-3425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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