Provider Demographics
NPI:1003325515
Name:TWAALFHOVEN, NICOLE COURTNEY (LMHC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:COURTNEY
Last Name:TWAALFHOVEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 24TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4818
Mailing Address - Country:US
Mailing Address - Phone:301-500-0311
Mailing Address - Fax:
Practice Address - Street 1:6200 BALTIMORE AVE STE 300
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1054
Practice Address - Country:US
Practice Address - Phone:301-500-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLPC8520101YM0800X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP5845OtherCOUNSELOR