Provider Demographics
NPI:1407624018
Name:DANDRIDGE, NICOLE LATRICE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LATRICE
Last Name:DANDRIDGE
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:PO BOX 7173
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0173
Mailing Address - Country:US
Mailing Address - Phone:757-598-2369
Mailing Address - Fax:
Practice Address - Street 1:580 CITY CENTER BLVD STE 5
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1880
Practice Address - Country:US
Practice Address - Phone:855-424-3656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical