Individual
NICOLE REYNOLDS SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
1005 S 3RD ST, MOUNT VERNON, WA 98273-4301
(360) 419-3612
(360) 419-3605
Mailing address
1701 30TH ST, BELLINGHAM, WA 98225-7603
(310) 210-8662
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
RC00058160
WA
1041C0700X
Clinical Social Worker
ASW18384
CA
1041C0700X
Clinical Social Worker
Primary
LW 60064972
WA
1041S0200X
School Social Worker
443673R
WA
1041S0200X
School Social Worker
PPSC #060034254
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSIX593
DMH
CA
Enumeration date
03/20/2007
Last updated
01/20/2010
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