Individual
EDNA CHISM NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3309 WINTHROP AVE, 90, FORT WORTH, TX 76116-5614
(214) 886-4872
Mailing address
8628 PAPER BIRCH LN, FORT WORTH, TX 76123-5058
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
12258
TX
1041C0700X
Clinical Social Worker
Primary
55023
TX
Other
Enumeration date
04/22/2014
Last updated
11/22/2024
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