Individual
MR. JEFFERSON NICHOLS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LBSW
Contact information
Practice address
24354 ECORSE RD, TAYLOR, MI 48180-1643
(313) 292-5300
Mailing address
24354 ECORSE RD, TAYLOR, MI 48180-1643
(313) 292-5300
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6802084389
MI
Other
Enumeration date
02/15/2013
Last updated
02/15/2013
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