MEDICARE: MS. JANET C. NICHOLSON ED.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810002336	VA
2	103T00000X	Psychologist	0810002336	VA
3	103TP2701X	Group Psychotherapy Psychologist	0810002336	VA

General Provider Information

NPI Number	:	1326075045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANET C. NICHOLSON ED.D.

Provider Business Mailing Address
First Line	:	5275 LEE HWY
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-532-4892
Fax Number	:	703-237-3105

Provider Business Practice Location Address
First Line	:	5275 LEE HWY
Second Line	:	SUITE 200
City	:	ARLINGTON
State	:	VA
Zip	:	22207-1619
Country	:	US
Telephone Number	:	703-532-4892
Fax Number	:	703-237-3105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	09/11/2025

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