Provider Demographics
NPI:1679725634
Name:NICE, KEN (MSW, LGSW)
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:NICE
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 3RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW MARTINSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26155-1403
Mailing Address - Country:US
Mailing Address - Phone:304-455-3035
Mailing Address - Fax:
Practice Address - Street 1:761 3RD ST
Practice Address - Street 2:
Practice Address - City:NEW MARTINSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26155-1403
Practice Address - Country:US
Practice Address - Phone:304-455-3035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health