Individual
THERESA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
660 PROSPECT AVE 3RD FL, HARTFORD, CT 06105-4245
(860) 337-7178
(203) 439-2087
Mailing address
660 PROSPECT AVE STE 3, HARTFORD, CT 06105-4245
(860) 337-7178
(203) 439-2087
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
000235
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
815373713
—
CT
Enumeration date
02/15/2018
Last updated
02/15/2018
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