Provider Demographics
NPI:1194308320
Name:MCLEOD, NICOLE NATASHA (PMHNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:NATASHA
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2794 SUGAR PINE CT
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1588
Mailing Address - Country:US
Mailing Address - Phone:610-299-4704
Mailing Address - Fax:
Practice Address - Street 1:2794 SUGAR PINE CT
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1588
Practice Address - Country:US
Practice Address - Phone:610-299-4704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2044692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry