Individual
AMY EVON NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2540 N GALLOWAY AVE STE 105, MESQUITE, TX 75150-4897
(832) 680-7112
Mailing address
11212 ERICH DR, BALCH SPRINGS, TX 75180-2006
(832) 680-7112
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
103582
TX
Other
Enumeration date
02/01/2024
Last updated
02/01/2024
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