Provider Demographics
NPI:1073206165
Name:LOUIS, NANCY S
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MITCHELLVILLE RD STE A414
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3142
Mailing Address - Country:US
Mailing Address - Phone:732-581-8728
Mailing Address - Fax:
Practice Address - Street 1:4000 MITCHELLVILLE RD STE A414
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3142
Practice Address - Country:US
Practice Address - Phone:732-581-8728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LG500836181041C0700X
MD300911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical