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General NPI Number Information
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NPI Number | 1417072356
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Entity Type | Individual
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Provider Name | NICOLE REYNOLDS SMALL MSW, LICSW
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Gender | Female
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 1005 S 3RD ST
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City | MOUNT VERNON
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State | WA
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Zip | 98273-4301
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Country | US
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Telephone | 360-419-3612
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Fax | 360-419-3605
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Provider Business Mailing Address
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Address Line | 1701 30TH ST
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City | BELLINGHAM
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State | WA
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Zip | 98225-7603
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Country | US
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Telephone | 310-210-8662
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ASW18384
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | PPSC #060034254
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | RC00058160
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 443673R
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW 60064972
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License Number State | WA
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