Provider Demographics
NPI:1619249380
Name:NICHOLS, DENA E (MS)
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16710 NE 79TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16710 NE 79TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4466
Practice Address - Country:US
Practice Address - Phone:425-941-1275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60163959101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health