Provider Demographics
NPI:1407035926
Name:CHRISTINE M. NICHOLSON, P.A.
Entity Type:Organization
Organization Name:CHRISTINE M. NICHOLSON, P.A.
Other - Org Name:CHRISTINE M. NICHOLSON, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:360-683-4845
Mailing Address - Street 1:11205 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7031
Mailing Address - Country:US
Mailing Address - Phone:360-683-4845
Mailing Address - Fax:425-285-0344
Practice Address - Street 1:530B N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-683-4845
Practice Address - Fax:425-285-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003423103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000N6325Medicaid