Provider Demographics
NPI:1760053136
Name:SULLIVAN NICHOLSON, THALIA PITSILLIDOU (PHD)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:PITSILLIDOU
Last Name:SULLIVAN NICHOLSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 PINE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-5247
Mailing Address - Country:US
Mailing Address - Phone:530-423-3714
Mailing Address - Fax:
Practice Address - Street 1:140 PINE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5247
Practice Address - Country:US
Practice Address - Phone:530-423-3714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35995103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist