Provider Demographics
NPI:1023246766
Name:FARRIS, NICOLE (MS/EDS, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:MS/EDS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 SILVERGATE WAY # 906E
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2548
Mailing Address - Country:US
Mailing Address - Phone:301-219-8559
Mailing Address - Fax:301-731-2082
Practice Address - Street 1:18221-D FLOWER HILL WAY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-5333
Practice Address - Country:US
Practice Address - Phone:301-219-8559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health