Provider Demographics
NPI:1881367118
Name:ROBIN C NICHOLAS, PA
Entity type:Organization
Organization Name:ROBIN C NICHOLAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-806-9232
Mailing Address - Street 1:1413 S PATRICK DR STE 9
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4374
Mailing Address - Country:US
Mailing Address - Phone:321-806-9232
Mailing Address - Fax:
Practice Address - Street 1:1413 S PATRICK DR STE 9
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4374
Practice Address - Country:US
Practice Address - Phone:321-806-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty