Provider Demographics
NPI:1720770241
Name:ZIMMERMAN, NUQUANNA A (LGPC)
Entity Type:Individual
Prefix:
First Name:NUQUANNA
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:NUQUANNA
Other - Middle Name:A
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:6801 TOWNBROOK DR APT D
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5637
Mailing Address - Country:US
Mailing Address - Phone:443-839-8157
Mailing Address - Fax:
Practice Address - Street 1:1208 E CHURCHVILLE RD STE 300
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3485
Practice Address - Country:US
Practice Address - Phone:410-893-4600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health