Provider Demographics
NPI:1023876166
Name:NUCKOLLS, FARHEEN NAVEED
Entity type:Individual
Prefix:
First Name:FARHEEN
Middle Name:NAVEED
Last Name:NUCKOLLS
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 1:1301 N 33RD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-6898
Mailing Address - Country:US
Mailing Address - Phone:804-298-9724
Mailing Address - Fax:
Practice Address - Street 1:1301 N 33RD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-6898
Practice Address - Country:US
Practice Address - Phone:804-298-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103850101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)