Individual
AMBER NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACSW
Contact information
Practice address
7907 OSTROW ST STE F, SAN DIEGO, CA 92111-3635
(330) 469-1352
Mailing address
3814 CRESTVIEW AVE SE, WARREN, OH 44484-3359
(330) 469-1352
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
114221
CA
1041C0700X
Clinical Social Worker
Primary
S.2005109
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2871101
—
OH
Enumeration date
07/20/2020
Last updated
04/18/2023
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