Provider Demographics
NPI:1861812091
Name:GREEN, NICOLE (LCPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:
Last Name:GREEN
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 1:6707 WHITESTONE RD
Mailing Address - Street 2:106
Mailing Address - City:WOODLAWN
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6707 WHITESTONE RD
Practice Address - Street 2:106
Practice Address - City:WOODLAWN
Practice Address - State:MD
Practice Address - Zip Code:21207-4106
Practice Address - Country:US
Practice Address - Phone:410-265-8737
Practice Address - Fax:410-265-1258
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional