Provider Demographics
NPI:1942937099
Name:NICHOLSON, DAWN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
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 1:4768 TIMBER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8034
Mailing Address - Country:US
Mailing Address - Phone:850-516-2896
Mailing Address - Fax:
Practice Address - Street 1:4300 BAYOU BLVD STE 27
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2671
Practice Address - Country:US
Practice Address - Phone:850-466-7127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW202831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW20283OtherLICENSED CLINICAL SOCIAL WORKER