Provider Demographics
NPI:1679626113
Name:NICHOLS, DAVID WAYNE (MSHS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WAYNE
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 THREE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4207
Mailing Address - Country:US
Mailing Address - Phone:302-838-5265
Mailing Address - Fax:
Practice Address - Street 1:2600 W 9TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-2040
Practice Address - Country:US
Practice Address - Phone:610-497-7249
Practice Address - Fax:610-497-7654
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)