Provider Demographics
NPI:1710919030
Name:BARBER, NICOLE C (MA, MDIV, CAS, LCPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:BARBER
Suffix:
Gender:F
Credentials:MA, MDIV, CAS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 SECURITY BLVD
Mailing Address - Street 2:THE RENAISSANCE CENTER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4018
Mailing Address - Country:US
Mailing Address - Phone:410-265-7291
Mailing Address - Fax:410-265-7294
Practice Address - Street 1:6665 SECURITY BLVD
Practice Address - Street 2:THE RENAISSANCE CENTER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4018
Practice Address - Country:US
Practice Address - Phone:410-265-7291
Practice Address - Fax:410-265-7294
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0988101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404292100Medicaid