Provider Demographics
NPI:1447860143
Name:COLLISON, NICOLE CONRAD (LCSW-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CONRAD
Last Name:COLLISON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:7837 HAROLD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-3302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7837 HAROLD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21222-3302
Practice Address - Country:US
Practice Address - Phone:410-382-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical