Provider Demographics
NPI:1689131252
Name:WEST, NICOLE NAKIA
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:NAKIA
Last Name:WEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 GWYNNS FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2923
Mailing Address - Country:US
Mailing Address - Phone:443-210-1042
Mailing Address - Fax:
Practice Address - Street 1:2741 GWYNNS FALLS PKWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2923
Practice Address - Country:US
Practice Address - Phone:443-210-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09877104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker