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Individual

BRANDON NICHOLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3415 GILMER CT APT C, MONTGOMERY, AL 36105-2324
(304) 254-6499
Mailing address
3415 GILMER CT APT C, MONTGOMERY, AL 36105-2324

Taxonomy

Speciality
Code
Description
License number
State
103TP0814X
Psychoanalysis Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10374773
LICENSE NO
AL
Enumeration date
03/26/2022
Last updated
03/26/2022
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