Provider Demographics
NPI:1144061581
Name:NICOME, ASADA MARISSA
Entity type:Individual
Prefix:
First Name:ASADA
Middle Name:MARISSA
Last Name:NICOME
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 1:1512 ROUNDHILL RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2211
Mailing Address - Country:US
Mailing Address - Phone:347-743-5655
Mailing Address - Fax:
Practice Address - Street 1:1512 ROUNDHILL RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2211
Practice Address - Country:US
Practice Address - Phone:347-743-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor