Provider Demographics
NPI:1447010095
Name:NICHOLLS, SHANIQUE
Entity type:Individual
Prefix:
First Name:SHANIQUE
Middle Name:
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 KINGS PASSAGE DR APT 2C
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6085
Mailing Address - Country:US
Mailing Address - Phone:804-938-7429
Mailing Address - Fax:
Practice Address - Street 1:9327 MIDLOTHIAN TPKE STE 1D
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4965
Practice Address - Country:US
Practice Address - Phone:528-308-0186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health