Individual
MARY ROSE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, CADCIII
Contact information
Practice address
207 SW 1ST ST, ENTERPRISE, OR 97828-1203
(541) 426-4524
(541) 426-3035
Mailing address
207 SW 1ST ST, P.O. BOX 268, ENTERPRISE, OR 97828-1203
(541) 426-4524
(541) 426-3035
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
L1978
OR
1041C0700X
Clinical Social Worker
L1978
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
210511
—
OR
Enumeration date
07/19/2006
Last updated
02/07/2008
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