Individual
MRS. DONALISA JUNE MCNICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW, LCDC III
Contact information
Practice address
115 S. REYNOLDS RD., TOLEDO, OH 43615
(419) 725-6631
(419) 725-6635
Mailing address
115 S. REYNOLDS RD., TOLEDO, OH 43615
(419) 725-6631
(419) 725-6635
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.081164
OH
104100000X
Social Worker
Primary
S.0024320
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0276549
—
OH
Enumeration date
09/20/2016
Last updated
09/18/2019
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