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General NPI Number Information
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NPI Number | 1396089934
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Entity Type | Individual
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Provider Name | MONIQUE L NICHOLSON
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Gender | Female
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 2526 N MAIN ST
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City | DANVILLE
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State | VA
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Zip | 24540-2333
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Country | US
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Telephone | 434-836-9510
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 YOUNGS MILL RD
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City | GREENSBORO
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State | NC
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Zip | 27406-9066
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Country | US
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Telephone | 336-324-9333
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 8787
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202007677
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License Number State | VA
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