Provider Demographics
NPI:1477089043
Name:NICHOLLS, TERRANCE KURT (LMHC)
Entity Type:Individual
Prefix:
First Name:TERRANCE
Middle Name:KURT
Last Name:NICHOLLS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 DAVID HOOPER PL
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1909
Mailing Address - Country:US
Mailing Address - Phone:201-664-3329
Mailing Address - Fax:
Practice Address - Street 1:280 DOBBS FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1900
Practice Address - Country:US
Practice Address - Phone:973-886-8209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health