Individual
MARY NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2404 BLUE HAVEN DR, NEW IBERIA, LA 70563-2133
(337) 315-4061
Mailing address
2404 BLUE HAVEN DR, NEW IBERIA, LA 70563-2133
(337) 315-4061
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
12812
LA
Other
Enumeration date
05/17/2018
Last updated
05/17/2018
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