Provider Demographics
NPI:1285763102
Name:NICHOLS, EVELYN LORRAINE (LICENSED INDEPENDENT)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:LORRAINE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6009 43RD STREET
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1510
Mailing Address - Country:US
Mailing Address - Phone:301-927-0427
Mailing Address - Fax:301-927-0427
Practice Address - Street 1:1012 14TH STREET NW
Practice Address - Street 2:FIRST HOME CARE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-737-2554
Practice Address - Fax:202-737-3261
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLI2001521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical