Provider Demographics
NPI:1114520327
Name:MORENCY, NIKITA SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:NIKITA
Middle Name:SUZANNE
Last Name:MORENCY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:SUZANNE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3492 HIGHWAY 5 APT 101
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3492 HIGHWAY 5 APT 101
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6909
Practice Address - Country:US
Practice Address - Phone:678-739-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0056021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical