Individual
BRENDA NICKOLAISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4715 VIEWRIDGE AVE STE 230, SAN DIEGO, CA 92123-1680
(800) 257-8715
(800) 819-1655
Mailing address
12608 CAMPANA DR, DEL VALLE, TX 78617-3621
(402) 730-1302
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
40809
TX
Other
Enumeration date
09/05/2006
Last updated
03/03/2010
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