Provider Demographics
NPI:1912284993
Name:NICHOLS, CHRISTINE RENEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:RENEE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 VILLAGE LANE
Mailing Address - Street 2:NEW WILMINGTON
Mailing Address - City:NEW WILMINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:16142
Mailing Address - Country:US
Mailing Address - Phone:215-355-6525
Mailing Address - Fax:267-989-1703
Practice Address - Street 1:1030 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-355-6525
Practice Address - Fax:267-989-1703
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0129341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical