Provider Demographics
NPI:1972956076
Name:LAWRENCE, NICOLE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 LEONARDTOWN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4614
Mailing Address - Country:US
Mailing Address - Phone:301-335-7811
Mailing Address - Fax:301-560-8606
Practice Address - Street 1:3600 LEONARDTOWN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-4614
Practice Address - Country:US
Practice Address - Phone:301-335-7811
Practice Address - Fax:301-560-8606
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC5000805161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical