Provider Demographics
NPI:1114383809
Name:NIMMONS, NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:NIMMONS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:ALERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2057 PULASKI HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-3744
Mailing Address - Country:US
Mailing Address - Phone:443-877-4044
Mailing Address - Fax:443-967-0077
Practice Address - Street 1:2057 PULASKI HWY STE 4
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-3744
Practice Address - Country:US
Practice Address - Phone:443-877-4044
Practice Address - Fax:443-967-0077
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT3391106H00000X
DEFT0000042106H00000X
MDLCM660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist