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NPI Code Detail

MEDICARE: NICKOLAUS KING LCSW-C

MEDICARE: NICKOLAUS KING LCSW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker28530MD
21041C0700XClinical Social WorkerCW025578PA
31041C0700XClinical Social Worker44SC06544300NJ
41041C0700XClinical Social WorkerLC200004715DC
51041C0700XClinical Social WorkerQ1-0012675DE
6101YM0800XMental Health CounselorQ1-0012675DE

General Provider Information

NPI Number : 1124758602
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICKOLAUS KING LCSW-C
Provider Business Mailing Address
First Line : 4690 MILLENNIUM DR STE 300
Second Line :
City : BELCAMP
State : MD
Zip : 21017-1527
Country : US
Telephone Number : 410-656-9010
Fax Number :
Provider Business Practice Location Address
First Line : 10715 CHARTER DR STE 130
Second Line :
City : COLUMBIA
State : MD
Zip : 21044-2892
Country : US
Telephone Number : 410-656-9010
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2022
Last Update Date : 04/16/2026

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