Provider Demographics
NPI:1659454791
Name:GARRIS, NICOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:GARRIS
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 1:1050 W PERIMETER RD
Mailing Address - Street 2:#56
Mailing Address - City:ANDREWS AFB
Mailing Address - State:MD
Mailing Address - Zip Code:20762-6601
Mailing Address - Country:US
Mailing Address - Phone:240-857-9680
Mailing Address - Fax:240-857-7092
Practice Address - Street 1:1050 W PERIMETER RD
Practice Address - Street 2:#56
Practice Address - City:ANDREWS AFB
Practice Address - State:MD
Practice Address - Zip Code:20762-6601
Practice Address - Country:US
Practice Address - Phone:240-857-9680
Practice Address - Fax:240-857-7092
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0710161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical