Provider Demographics
NPI:1932344512
Name:CANCHOLA, NICOLE A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:A
Last Name:CANCHOLA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 W BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3227
Mailing Address - Country:US
Mailing Address - Phone:480-344-2000
Mailing Address - Fax:480-344-2000
Practice Address - Street 1:570 W BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3227
Practice Address - Country:US
Practice Address - Phone:480-344-2000
Practice Address - Fax:480-344-2000
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-129261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical