Basic Information
| Provider Information | |||||||||
| NPI: | 1639651276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | DEE | ||||||||
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| Credential: | LCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9019 SCOTTS BLUFF LN | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238329250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8044336077 | ||||||||
| FaxNumber: | 8042613962 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 ENTERPRISE PKWY | ||||||||
| Address2: | |||||||||
| City: | HENRICO | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232946341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042612090 | ||||||||
| FaxNumber: | 8042613962 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2018 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 0701007862 | VA | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.