Provider Demographics
NPI:1891548533
Name:NICHOLS, HEATHER ANN (CASAC-T)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 COURT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3803
Mailing Address - Country:US
Mailing Address - Phone:315-624-9835
Mailing Address - Fax:
Practice Address - Street 1:1213 COURT ST STE 100
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3803
Practice Address - Country:US
Practice Address - Phone:315-624-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39354101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)