Individual
KRISTEN NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, QMHP, CADC
Contact information
Practice address
325 IL ROUTE 2, DIXON, IL 61021-9118
(815) 284-6611
Mailing address
325 IL ROUTE 2, DIXON, IL 61021-9118
(815) 284-6611
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25265
IL
101YM0800X
Mental Health Counselor
—
IL
Other
Enumeration date
09/28/2010
Last updated
03/20/2014
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