Individual
AMY NICKEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
914 MISSION AVE FL 3, SAN RAFAEL, CA 94901-6106
(415) 457-6964
Mailing address
914 MISSION AVE FL 3, SAN RAFAEL, CA 94901-6106
(415) 457-6964
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/28/2011
Last updated
02/28/2011
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