Individual
MR. CHARLES NICKELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
762 GRISWOLD AVE, SAN FERNANDO, CA 91340-2105
(747) 500-9405
Mailing address
386 MERRILL AVE, GLENDALE, CA 91206-4108
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CI42120324
CA
Other
Enumeration date
04/09/2024
Last updated
04/09/2024
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