Provider Demographics
NPI:1164688487
Name:KEESEE, NICOLE MARGRIT-ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARGRIT-ANN
Last Name:KEESEE
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 1:1200 NORTH VEITCH STREER
Mailing Address - Street 2:APT 404
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-7059
Mailing Address - Country:US
Mailing Address - Phone:703-601-0692
Mailing Address - Fax:703-601-0801
Practice Address - Street 1:2400 ARMY PENTAGON DRIVE
Practice Address - Street 2:DAAR-MD
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20310-2400
Practice Address - Country:US
Practice Address - Phone:703-601-0692
Practice Address - Fax:703-601-0801
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR849-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical