Individual
KAITLYN E NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9202 CENTER OAK CT, MECHANICSVILLE, VA 23116-2744
(804) 207-6737
Mailing address
71 MAPLE RD, KINGS PARK, NY 11754-3127
(347) 723-8761
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
35145
NY
104100000X
Social Worker
107673
NY
1041C0700X
Clinical Social Worker
Primary
0904016773
VA
Other
Enumeration date
12/15/2020
Last updated
08/26/2024
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