Doctor Name: | SUZANNE LEA NICHOLS |
NPI Number: | 1275701260 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | SSP |
License Number: | 1204 |
Business Practice Address: | 111 School St Romney, WV - 267571522 |
Business Phone Number: | 3048223528 |
Business Fax Number: | |
Mailing Address: | 111 School St., ROMNEY |
State: | WV |
Postal Code: | 26757 |
Phone Number: | 3048223528 |
Fax Number: | |
NPI Enumeration Date: | 02/13/2008 |
NPI Last Update Date: | 02/13/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 1204 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |