Provider Demographics
NPI:1912718339
Name:DOLLARHIDE, NICHOLE (PPS, LEP)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:DOLLARHIDE
Suffix:
Gender:F
Credentials:PPS, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 F ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1036
Mailing Address - Country:US
Mailing Address - Phone:707-572-0099
Mailing Address - Fax:707-268-0813
Practice Address - Street 1:714 F ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-1036
Practice Address - Country:US
Practice Address - Phone:707-572-0099
Practice Address - Fax:707-268-0813
Is Sole Proprietor?:No
Enumeration Date:2025-01-15
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3878103T00000X
CA210066774103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103T00000XBehavioral Health & Social Service ProvidersPsychologist