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Individual

DR. CAROL WILLIAMS NICKELSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
20925 PROFESSIONAL PLZ STE 230, ASHBURN, VA 20147-3403
(703) 621-7121
Mailing address
21385 GLEBE VIEW DR, BROADLANDS, VA 20148-3629
(703) 723-0119

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
103TC0700X
Clinical Psychologist
Primary
0810007253
VA

Other

Enumeration date
04/02/2020
Last updated
10/04/2020
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