Provider Demographics
NPI:1922852177
Name:NICHOLSON, ANDREA (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 NORTHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-5054
Mailing Address - Country:US
Mailing Address - Phone:561-305-3910
Mailing Address - Fax:
Practice Address - Street 1:702 W HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1913
Practice Address - Country:US
Practice Address - Phone:928-778-9207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor