Provider Demographics
NPI:1902649882
Name:NICHOLS, OLIVIA DANIELLE (LSW)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:DANIELLE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5996 E 64TH AVE # 80022
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-3317
Mailing Address - Country:US
Mailing Address - Phone:720-792-0791
Mailing Address - Fax:
Practice Address - Street 1:1720 S BELLAIRE ST STE 909
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4333
Practice Address - Country:US
Practice Address - Phone:303-476-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009925464104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker