Provider Demographics
NPI:1669484994
Name:NICHOLSON, ANNE B (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:B
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-877-9140
Mailing Address - Fax:757-877-3925
Practice Address - Street 1:6515 GEO WASH MEM HWY STE 100
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:VA
Practice Address - Zip Code:23692
Practice Address - Country:US
Practice Address - Phone:757-877-9140
Practice Address - Fax:757-877-3925
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904003498104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA268398OtherANTHEM
517071OtherVALUE OPTIONS
VA002882H83Medicare ID - Type Unspecified