Provider Demographics
NPI:1427489186
Name:HARRISON, NINA (LGSW)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 TROUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1568
Mailing Address - Country:US
Mailing Address - Phone:202-423-4630
Mailing Address - Fax:
Practice Address - Street 1:5504 TROUT RUN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1568
Practice Address - Country:US
Practice Address - Phone:202-423-4630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLG500781381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical