Provider Demographics
NPI:1992068118
Name:DECHIRICO, NICOLE (LCSW-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DECHIRICO
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 1:5058 DORSEY HALL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7849
Mailing Address - Country:US
Mailing Address - Phone:443-840-6496
Mailing Address - Fax:
Practice Address - Street 1:5058 DORSEY HALL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7849
Practice Address - Country:US
Practice Address - Phone:443-840-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD144321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical