Provider Demographics
NPI:1023990215
Name:NICHOLES, ANGELLA M (LMSW)
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:M
Last Name:NICHOLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11935 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-7990
Mailing Address - Country:US
Mailing Address - Phone:208-590-1461
Mailing Address - Fax:
Practice Address - Street 1:3770 E AMITY AVE UNIT 106
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-1194
Practice Address - Country:US
Practice Address - Phone:208-750-8235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8921318104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker