Provider Demographics
NPI:1124660600
Name:SAMUEL, NAKISHA ALANA (LICSW)
Entity type:Individual
Prefix:
First Name:NAKISHA
Middle Name:ALANA
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 45TH AVE APT 517
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1661
Mailing Address - Country:US
Mailing Address - Phone:347-261-3565
Mailing Address - Fax:
Practice Address - Street 1:915 RHODE ISLAND AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4153
Practice Address - Country:US
Practice Address - Phone:202-232-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500820951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical