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General NPI Number Information
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NPI Number | 1265910525
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Entity Type | Individual
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Provider Name | ANTOINE NICHOLS LPC
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Gender | Male
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 01/18/2024
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Provider Practice Location Address
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Address Line | 355 CRAWFORD ST STE 816
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City | PORTSMOUTH
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State | VA
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Zip | 23704-2825
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Country | US
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Telephone | 757-966-1711
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Fax | 757-432-2971
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Provider Business Mailing Address
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Address Line | 2110 LYNDORA RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-8620
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Country | US
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Telephone | 757-641-8444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007726
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License Number State | VA
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