Healthcare Provider Details

I. General information

NPI: 1023232626
Provider Name (Legal Business Name): SUSAN CUMMINGS NICHOLSON PHD, LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 02/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 THIMBLE SHOALS BLVD A-3
NEWPORT NEWS VA
23606-2576
US

IV. Provider business mailing address

203 WOODBURNE LN
NEWPORT NEWS VA
23602-8363
US

V. Phone/Fax

Practice location:
  • Phone: 757-873-3401
  • Fax: 757-223-1165
Mailing address:
  • Phone: 757-869-2361
  • Fax: 757-223-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003048
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: