Provider Demographics
NPI:1699482018
Name:FORD, NICOLE MONIQUE (LCSW-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MONIQUE
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GEORGE AND MARION PHELPS LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4111
Mailing Address - Country:US
Mailing Address - Phone:410-222-1626
Mailing Address - Fax:
Practice Address - Street 1:1 GEORGE AND MARION PHELPS LN
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4111
Practice Address - Country:US
Practice Address - Phone:410-222-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical