Provider Demographics
NPI:1972763019
Name:NICHOLSON, BROOKELY
Entity type:Individual
Prefix:
First Name:BROOKELY
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKELY
Other - Middle Name:
Other - Last Name:SORRELLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-0728
Mailing Address - Country:US
Mailing Address - Phone:828-586-6600
Mailing Address - Fax:828-586-6601
Practice Address - Street 1:669 S HAYWOOD ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-6703
Practice Address - Country:US
Practice Address - Phone:828-456-2997
Practice Address - Fax:828-456-2996
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0082331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical