Provider Demographics
NPI:1033507611
Name:VERNON, NICHOLE (PHD , SB RPT)
Entity type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:
Last Name:VERNON
Suffix:
Gender:F
Credentials:PHD , SB RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9926 NEW POINTE DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-3756
Mailing Address - Country:US
Mailing Address - Phone:615-473-2947
Mailing Address - Fax:
Practice Address - Street 1:9926 NEW POINTE DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-3756
Practice Address - Country:US
Practice Address - Phone:615-473-2947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool