Provider Demographics
NPI:1194847277
Name:NICHOLAS, DONALD (BA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:NICHOLAS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SUFFOLK ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3642
Mailing Address - Country:US
Mailing Address - Phone:781-356-8017
Mailing Address - Fax:
Practice Address - Street 1:650 SUFFOLK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3642
Practice Address - Country:US
Practice Address - Phone:781-356-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)