Provider Demographics
NPI:1013214923
Name:WRIGHT, NICOLE S (MSW, LICSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MSW, LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 MAYCHECK LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1555
Mailing Address - Country:US
Mailing Address - Phone:202-236-3160
Mailing Address - Fax:
Practice Address - Street 1:12210 MAYCHECK LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1555
Practice Address - Country:US
Practice Address - Phone:202-236-3160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500779881041C0700X
MD179161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD265114900Medicaid