Provider Demographics
NPI:1609170745
Name:NICHOLSON, SHEENA RAE (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SHEENA
Middle Name:RAE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SHEENA
Other - Middle Name:RAE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:2917 DOGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26547-7056
Mailing Address - Country:US
Mailing Address - Phone:304-900-2002
Mailing Address - Fax:
Practice Address - Street 1:2917 DOGTOWN RD
Practice Address - Street 2:
Practice Address - City:REEDSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26547-7056
Practice Address - Country:US
Practice Address - Phone:304-900-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009436761041C0700X
WVDP009436761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical