Individual
KAREN NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
5268 GODWIN BLVD, SUFFOLK, VA 23434-8135
(757) 925-2227
Mailing address
5268 GODWIN BLVD, SUFFOLK, VA 23434-8135
(757) 925-2227
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
084-07-004
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5400635
—
VA
05
—
5409071
—
VA
05
—
5409098
—
VA
Enumeration date
10/06/2006
Last updated
07/08/2007
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