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General NPI Number Information
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NPI Number | 1366599524
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Entity Type | Individual
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Provider Name | MS. ELAINE J NICHOLAS
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Gender | Female
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 13585 SAN PABLO AVE FL 2
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City | RICHMOND
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State | CA
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Zip | 94806-3863
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Country | US
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Telephone | 510-942-4700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 156573
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-6573
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Country | US
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Telephone | 415-517-6857
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 124539350
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 99062
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License Number State | CA
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