Individual
MRS. MONICA NICOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
830 B ST, SAN RAFAEL, CA 94901-3003
(415) 459-5843
Mailing address
544 W K ST, BENICIA, CA 94510-3067
(707) 750-5108
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/21/2009
Last updated
04/04/2013
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