Provider Demographics
NPI:1265122113
Name:NICKS, PARIS LASHAY
Entity type:Individual
Prefix:
First Name:PARIS
Middle Name:LASHAY
Last Name:NICKS
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 1:829 CATOR AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1227
Mailing Address - Country:US
Mailing Address - Phone:202-322-8374
Mailing Address - Fax:
Practice Address - Street 1:3701 HAYES ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-1702
Practice Address - Country:US
Practice Address - Phone:202-322-8374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-12
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
DCLG2000014931041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No251S00000XAgenciesCommunity/Behavioral Health