Provider Demographics
NPI:1528647179
Name:SOLOMON, NICOLE LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOUISE
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LOUISE
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1576 FREEMAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23438-9614
Mailing Address - Country:US
Mailing Address - Phone:920-819-9813
Mailing Address - Fax:
Practice Address - Street 1:1576 FREEMAN MILL RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23438-9614
Practice Address - Country:US
Practice Address - Phone:920-819-9813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0230631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical