MEDICARE: NICHOLAS AND ASSOCIATES COUNSELING SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417575010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS AND ASSOCIATES COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	4318 GREEN CEDAR LN
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-2648
Country	:	US
Telephone Number	:	803-605-0066
Fax Number	:	804-271-5491

Provider Business Practice Location Address
First Line	:	4318 GREEN CEDAR LN
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-2648
Country	:	US
Telephone Number	:	803-605-0066
Fax Number	:	804-271-5491

Authorized Official
Title or Position	:	PRESIDENT/DIRECTOR
Name	:	ROBYN RENA NICHOLAS-BARNES
Credential	:	M.ED, RESIDENT-COUNS
Telephone Number	:	804-606-0066

Provider Enumeration Date	:	07/09/2020
Last Update Date	:	07/09/2020

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