Provider Demographics
NPI:1033507611
Name:VERNON, NICHOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:VERNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 MARTIN LUTHER KING JR AVE SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1328
Mailing Address - Country:US
Mailing Address - Phone:202-645-6330
Mailing Address - Fax:
Practice Address - Street 1:4201 MARTIN LUTHER KING JR AVE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1328
Practice Address - Country:US
Practice Address - Phone:202-645-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool