Provider Demographics
NPI:1871907337
Name:NICHOLSON, ALICIA (LPC)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GRAPEVINE
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-5549
Mailing Address - Country:US
Mailing Address - Phone:501-581-3479
Mailing Address - Fax:501-932-6379
Practice Address - Street 1:1308 OAK ST UNIT A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5339
Practice Address - Country:US
Practice Address - Phone:501-581-3479
Practice Address - Fax:501-932-6379
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1610156101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional