Provider Demographics
NPI:1083853519
Name:WEILER, NICHOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:WEILER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W BRAMBLETON AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1505
Mailing Address - Country:US
Mailing Address - Phone:757-450-7660
Mailing Address - Fax:757-500-7866
Practice Address - Street 1:250 W BRAMBLETON AVE STE 101
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1505
Practice Address - Country:US
Practice Address - Phone:757-450-7660
Practice Address - Fax:757-500-7866
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
VA09040070321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical