Provider Demographics
NPI:1629483714
Name:HENN, NICOLE (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HENN
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 TOWER OAKS BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4377
Mailing Address - Country:US
Mailing Address - Phone:301-525-8150
Mailing Address - Fax:
Practice Address - Street 1:2000 TOWER OAKS BLVD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4282
Practice Address - Country:US
Practice Address - Phone:301-444-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133003139103K00000X
MI7401000860103K00000X
MDLBA1607103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst