Individual
MIKE LYLE NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
B.S.
Contact information
Practice address
1616 CORNWALL AVE STE 205, BELLINGHAM, WA 98225
(360) 676-6177
Mailing address
1616 CORNWALL AVE STE 205, BELLINGHAM, WA 98225-4642
(360) 676-6177
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
LW60717124
WA
104100000X
Social Worker
LW60717124
WA
1041C0700X
Clinical Social Worker
Primary
LW60717124
WA
Other
Enumeration date
12/18/2007
Last updated
08/08/2018
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