Provider Demographics
NPI:1780971952
Name:NICOLAS, KIMBERLY PARKER (PHD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PARKER
Last Name:NICOLAS
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 1:9025 FOREST HILL AVE STE 2A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3025
Mailing Address - Country:US
Mailing Address - Phone:804-668-7220
Mailing Address - Fax:
Practice Address - Street 1:9025 FOREST HILL AVE STE 2A
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3025
Practice Address - Country:US
Practice Address - Phone:804-668-7220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945182Medicaid