Most Relevant Information
Provider Data
| NPI Number: | 1003374752 |
| Provider Name: | NICHOLAS A ETHERIDGE LCPC, NCC |
| Entity Type: | Individual |
| Taxonomy Code: | 101YP2500X |
| Specialty: | Counselor |
| License Number: | LC11427 |
Most Important Dates
| Enumeration Date: | 03/12/2019 |
| Last Updated: | 05/24/2021 |
Provider Practice Location
5500 HARFORD RD STE 201
BALTIMORE
MD
212142290
Practice Location Phone/Fax
| Phone: | 6677069091 |
| Fax: |
Provider Mailing Location
5500 HARFORD RD STE 201
BALTIMORE
MD
212142290
Provider Mailing Phone/Fax
| Phone: | 6677069091 |
| Fax: |