Provider Demographics
NPI:1821579244
Name:LICHT, NINA LESLIE (LPCMH)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:LESLIE
Last Name:LICHT
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 HUNTING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3717
Mailing Address - Country:US
Mailing Address - Phone:302-593-3899
Mailing Address - Fax:
Practice Address - Street 1:99 PASSMORE DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1548
Practice Address - Country:US
Practice Address - Phone:302-478-9411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health