Individual
CLINTON JOHN NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP00002406
Contact information
Practice address
1 COLVILLE STREET, NESPELEM, WA 99155
(509) 634-2727
Mailing address
PO BOX 150, NESPELEM, WA 99155-0150
(509) 634-2727
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CP00002406
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992957
—
WA
Enumeration date
04/09/2010
Last updated
04/09/2010
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