Provider Demographics
NPI:1780932376
Name:SMITH, NIKKI MONIQUE CHAPPLE (LCPC)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:MONIQUE CHAPPLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 IDYLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3617
Mailing Address - Country:US
Mailing Address - Phone:443-310-6446
Mailing Address - Fax:
Practice Address - Street 1:1219 IDYLWOOD RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3617
Practice Address - Country:US
Practice Address - Phone:443-310-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4887101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional