Provider Demographics
NPI:1336884980
Name:LOMBARDO, NICHOLE ALISA (MA, LGPC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ALISA
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:MA, LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 WOODVALE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8675
Mailing Address - Country:US
Mailing Address - Phone:240-925-6647
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 1009
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3398
Practice Address - Country:US
Practice Address - Phone:410-768-5988
Practice Address - Fax:410-768-5989
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12637101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health