Provider Demographics
NPI:1104266543
Name:NICHOLSON, NANCY MAE (MSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:MAE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2691 SYLVAN SHORES DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3936
Mailing Address - Country:US
Mailing Address - Phone:248-842-0068
Mailing Address - Fax:
Practice Address - Street 1:2691 SYLVAN SHORES DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3936
Practice Address - Country:US
Practice Address - Phone:248-842-0068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-30
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MI68010889931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical