Provider Demographics
NPI:1821161787
Name:NICHOLS, ANDREW NICHOLS C (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ANDREW NICHOLS
Middle Name:C
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 S NAPERVILLE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5846
Mailing Address - Country:US
Mailing Address - Phone:630-260-0606
Mailing Address - Fax:630-260-1049
Practice Address - Street 1:1761 S NAPERVILLE RD
Practice Address - Street 2:STE 200
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5846
Practice Address - Country:US
Practice Address - Phone:630-260-0606
Practice Address - Fax:630-260-1049
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490064441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical