Provider Demographics
NPI:1114637204
Name:NICOLSON, DONNA (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:NICOLSON
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13302 LA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2225
Mailing Address - Country:US
Mailing Address - Phone:210-379-3559
Mailing Address - Fax:
Practice Address - Street 1:18670 FORTY SIX PKWY UNIT 1
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-6888
Practice Address - Country:US
Practice Address - Phone:210-617-3655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional