Individual
DEMETRIOUS TRA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
141 EDNAM DR STE 104, CHARLOTTESVILLE, VA 22903-4629
(434) 202-4080
Mailing address
4927 SHERIDAN ST, CHARLOTTESVILLE, VA 22902-9026
(757) 737-9216
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
0704017770
VA
Other
Enumeration date
02/06/2025
Last updated
02/06/2025
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