Individual
BROOKE LANE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2403 PROFESSIONAL DR, SANTA ROSA, CA 95403-3007
(707) 544-3295
(707) 544-9011
Mailing address
2403 PROFESSIONAL DR, SANTA ROSA, CA 95403-3007
(707) 544-3295
(707) 544-9011
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033535364
—
CA
Enumeration date
03/11/2014
Last updated
03/29/2019
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