Provider Demographics
NPI:1043802036
Name:ANDREWS, NICOLE ANN (LCPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15820 MCMULLEN HWY SW APT A
Mailing Address - Street 2:
Mailing Address - City:CRESAPTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6618
Mailing Address - Country:US
Mailing Address - Phone:240-522-0885
Mailing Address - Fax:
Practice Address - Street 1:15820 MCMULLEN HWY SW APT A
Practice Address - Street 2:
Practice Address - City:CRESAPTOWN
Practice Address - State:MD
Practice Address - Zip Code:21502-6618
Practice Address - Country:US
Practice Address - Phone:240-522-0885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC11143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional