Provider Demographics
NPI:1316261506
Name:NICHOLSON, CASSIDY HEATHER (STNA, QMHS)
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:HEATHER
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:STNA, QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 DRESDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-4268
Mailing Address - Country:US
Mailing Address - Phone:614-822-8090
Mailing Address - Fax:
Practice Address - Street 1:3130 DRESDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-4268
Practice Address - Country:US
Practice Address - Phone:614-822-8090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X, 251S00000X
OH400426531104376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376K00000XNursing Service Related ProvidersNurse's Aide