Provider Demographics
NPI:1073272274
Name:MICHALSKI, NICHOLLE RIANE JOHNSTON (PHD)
Entity Type:Individual
Prefix:
First Name:NICHOLLE
Middle Name:RIANE JOHNSTON
Last Name:MICHALSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICHOLLE
Other - Middle Name:RIANE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2915 ADAMS PL
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1946
Mailing Address - Country:US
Mailing Address - Phone:509-850-1014
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPSY1695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical