Provider Demographics
NPI:1972613115
Name:NICHOLSON, CHRISTINE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:MARIE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11205 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7031
Mailing Address - Country:US
Mailing Address - Phone:360-683-4845
Mailing Address - Fax:425-285-0344
Practice Address - Street 1:530B N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-683-4845
Practice Address - Fax:425-285-9344
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM253103TC0700X
WA3423103TC0700X, 103TC2200X, 103TS0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00N925OtherANTHEM
NMNM00N925OtherBLUE CROSS, BLUE SHIELD
NM22234OtherPRESBYTERIAN HEALTH
NM100140OtherVALUE OPTIONS
NM000N6325Medicaid