Provider Demographics
NPI:1881909455
Name:NICHOLSON, NICOLE C (MS, CAS, NCC, LMHC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:C
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MS, CAS, NCC, LMHC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:C
Other - Last Name:SAVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1045 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2730
Mailing Address - Country:US
Mailing Address - Phone:315-472-4471
Mailing Address - Fax:315-472-1759
Practice Address - Street 1:1045 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2730
Practice Address - Country:US
Practice Address - Phone:315-472-4471
Practice Address - Fax:315-472-1759
Is Sole Proprietor?:No
Enumeration Date:2010-08-08
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP68122101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health