Provider Demographics
NPI:1942001797
Name:MYRICK, NIKIA C (MSW)
Entity type:Individual
Prefix:
First Name:NIKIA
Middle Name:C
Last Name:MYRICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-2429
Mailing Address - Country:US
Mailing Address - Phone:757-472-2136
Mailing Address - Fax:
Practice Address - Street 1:125 NAVAJO TRL
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-2429
Practice Address - Country:US
Practice Address - Phone:757-472-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060163151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical