Provider Demographics
NPI:1053991885
Name:KAZUBA, NICOLE DENISE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:KAZUBA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 CEDAR LN SE # 4048
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-6613
Mailing Address - Country:US
Mailing Address - Phone:703-975-6351
Mailing Address - Fax:
Practice Address - Street 1:278 CEDAR LN SE # 4048
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6613
Practice Address - Country:US
Practice Address - Phone:703-975-6351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional