Provider Demographics
NPI:1417591827
Name:NICHOLSON, MICHAEL (LPC-A)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CLEVELAND ST UNIT 293
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4573
Mailing Address - Country:US
Mailing Address - Phone:864-525-6971
Mailing Address - Fax:
Practice Address - Street 1:1990 AUGUSTA ST STE 204
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-6505
Practice Address - Country:US
Practice Address - Phone:864-525-6371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7218101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional