Provider Demographics
NPI:1407690951
Name:HARRIS, NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 W SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3270
Mailing Address - Country:US
Mailing Address - Phone:443-355-8504
Mailing Address - Fax:
Practice Address - Street 1:5800 8TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-1902
Practice Address - Country:US
Practice Address - Phone:202-292-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAO414103T00000X
DCPSYA200001361103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist