Provider Demographics
NPI:1932371069
Name:VANCE, NICOLE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 K ST NW
Mailing Address - Street 2:STE 405
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4425
Mailing Address - Country:US
Mailing Address - Phone:202-628-8848
Mailing Address - Fax:202-628-8849
Practice Address - Street 1:1003 K ST NW
Practice Address - Street 2:STE 405
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4425
Practice Address - Country:US
Practice Address - Phone:202-628-8848
Practice Address - Fax:202-628-8849
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC13879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional