Provider Demographics
NPI:1457585820
Name:NOZICKA, MARCO ANTONIO (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:NOZICKA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:ANTONIO
Other - Last Name:NOZICKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6881 RAEFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:910-423-6200
Mailing Address - Fax:910-429-0800
Practice Address - Street 1:6881 RAEFORD RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-2630
Practice Address - Country:US
Practice Address - Phone:910-423-6200
Practice Address - Fax:910-429-0800
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0063261041C0700X
IL149.0018241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical