Provider Demographics
NPI:1689980393
Name:NICHOLS, JANICE DENISE (MPA, LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:DENISE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MPA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11701 PALM LAKE DR APT 1411
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-0918
Mailing Address - Country:US
Mailing Address - Phone:904-598-4519
Mailing Address - Fax:
Practice Address - Street 1:11701 PALM LAKE DR APT 1411
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-0918
Practice Address - Country:US
Practice Address - Phone:904-598-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW99331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical