Provider Demographics
NPI:1194212845
Name:NICHOLSON, LEE ANNA MELISSA
Entity type:Individual
Prefix:MRS
First Name:LEE ANNA
Middle Name:MELISSA
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 LIN DO CT
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1832
Mailing Address - Country:US
Mailing Address - Phone:803-905-4427
Mailing Address - Fax:803-905-4431
Practice Address - Street 1:2014 CANADA DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-4918
Practice Address - Country:US
Practice Address - Phone:706-604-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health