Provider Demographics
NPI:1326075045
Name:NICHOLSON, JANET C (EDD)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:C
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 LEE HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1619
Mailing Address - Country:US
Mailing Address - Phone:703-532-4892
Mailing Address - Fax:703-237-3105
Practice Address - Street 1:5275 LEE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:703-532-4892
Practice Address - Fax:703-237-3105
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002336103TC0700X, 103T00000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC013435K57Medicare ID - Type Unspecified