Provider Demographics
NPI:1235731563
Name:NICKELBERRY, FELICIA CAMPBELL (LCPC)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:CAMPBELL
Last Name:NICKELBERRY
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 1:312 MARSHALL AVE STE 906
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4824
Mailing Address - Country:US
Mailing Address - Phone:240-432-4325
Mailing Address - Fax:
Practice Address - Street 1:312 MARSHALL AVE STE 906
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4824
Practice Address - Country:US
Practice Address - Phone:240-432-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10981101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health