Healthcare Provider Details

I. General information

NPI: 1982308169
Provider Name (Legal Business Name): TASHAWN MONIQUE NICHOLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SHADY AVE
PITTSBURGH PA
15206-4316
US

IV. Provider business mailing address

401 N HIGHLAND AVE
PITTSBURGH PA
15206-2926
US

V. Phone/Fax

Practice location:
  • Phone: 866-583-6003
  • Fax:
Mailing address:
  • Phone: 866-583-6003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014470
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: