Organization
LEAVE YOUR MARK LIFE COACHING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICKOLAS NICHOLS LMFT (LMFT/OWNER)
(757) 493-1514
Entity
Organization
Contact information
Practice address
762 INDEPENDENCE BLVD STE 786, VIRGINIA BEACH, VA 23455-6200
(757) 493-1514
Mailing address
762 INDEPENDENCE BLVD STE 786, VIRGINIA BEACH, VA 23455-6200
(757) 493-1514
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
Other
Enumeration date
09/06/2023
Last updated
09/06/2023
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