Individual
CONNIE SUE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, IAADC
Contact information
Practice address
702 PARK AVE, BETTENDORF, IA 52722-5684
(712) 389-0799
Mailing address
407 W 2ND ST, SIOUX CITY, IA 51103-4505
(712) 389-0799
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15118
IA
101YM0800X
Mental Health Counselor
Primary
001526
IA
Other
Enumeration date
06/10/2010
Last updated
11/03/2017
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