Provider Demographics
NPI:1053335042
Name:NICHOLS, WILLIAM GARY (LCSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GARY
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 21ST ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1752
Mailing Address - Country:US
Mailing Address - Phone:916-875-9889
Mailing Address - Fax:916-875-9970
Practice Address - Street 1:3331 POWER INN RD
Practice Address - Street 2:170
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-9889
Practice Address - Fax:916-875-9970
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALK95301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical