Provider Demographics
NPI:1417233792
Name:ROUGH, NICOLA DE MONTILLE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:NICOLA
Middle Name:DE MONTILLE
Last Name:ROUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:LOUISE
Other - Last Name:DE MONTILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:109 PARK WASHINGTON COURT
Mailing Address - Street 2:WASHINGTON SQUARE
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046
Mailing Address - Country:US
Mailing Address - Phone:703-533-5825
Mailing Address - Fax:703-533-8431
Practice Address - Street 1:109 PARK WASHINGTON COURT
Practice Address - Street 2:WASHINGTON SQUARE
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046
Practice Address - Country:US
Practice Address - Phone:703-533-5825
Practice Address - Fax:703-533-8431
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040087821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical