Individual
ETHAN NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, LAC, LMSW
Contact information
Practice address
2480 LLEWELLYN AVE, FORT MEADE, MD 20755-7081
(301) 677-8895
Mailing address
2005 TOWN CENTER BLVD UNIT 3441, ODENTON, MD 21113-1780
(985) 227-3897
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1548
LA
104100000X
Social Worker
12901
LA
1041C0700X
Clinical Social Worker
Primary
12901
LA
Other
Enumeration date
03/05/2015
Last updated
07/22/2024
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