Provider Demographics
NPI:1023465259
Name:NICHOLS, ALEXANDRA (PHD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:NICHOLS
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:PO BOX 2854
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-0854
Mailing Address - Country:US
Mailing Address - Phone:707-536-1856
Mailing Address - Fax:
Practice Address - Street 1:100 MEADOWCREEK DR STE 115
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1230
Practice Address - Country:US
Practice Address - Phone:415-843-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-17
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical