Provider Demographics
NPI:1811792021
Name:NICHOLS, DINA (MASTERS OF ARTS)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MASTERS OF ARTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11331 VERDI LN
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4311
Mailing Address - Country:US
Mailing Address - Phone:833-275-6378
Mailing Address - Fax:855-710-6394
Practice Address - Street 1:11331 VERDI LN
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326-4311
Practice Address - Country:US
Practice Address - Phone:833-275-6378
Practice Address - Fax:855-710-6394
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst