Provider Demographics
NPI:1427023779
Name:DEWAAL, NICK J (LCPC, NCC)
Entity type:Individual
Prefix:MR
First Name:NICK
Middle Name:J
Last Name:DEWAAL
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SUMTER DR
Mailing Address - Street 2:
Mailing Address - City:KEEDYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21756-1353
Mailing Address - Country:US
Mailing Address - Phone:301-432-2940
Mailing Address - Fax:
Practice Address - Street 1:1190 MOUNT AETNA RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6833
Practice Address - Country:US
Practice Address - Phone:301-514-5049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health