Healthcare Provider Details

I. General information

NPI: 1720260607
Provider Name (Legal Business Name): JOHN RANDALL NICHOLS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 STOCKTON ST
PRINCETON NJ
08540-6813
US

IV. Provider business mailing address

2685 PRINCETON PIKE
LAWRENCEVILLE NJ
08648-3640
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-0060
  • Fax:
Mailing address:
  • Phone: 609-882-7958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: