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General NPI Number Information
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NPI Number | 1528749629
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Entity Type | Individual
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Provider Name | STEVEN LYLE NICHOLSON LCSW, LICSW
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Gender | Male
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Dates
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Enumeration Date | 07/31/2023
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 650 PENNSYLVANIA AVE SE STE 440
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City | WASHINGTON
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State | DC
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Zip | 20003-4424
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Country | US
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Telephone | 202-544-5440
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Fax |
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Provider Business Mailing Address
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Address Line | 2512 Q ST NW APT 123
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City | WASHINGTON
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State | DC
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Zip | 20007-4395
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Country | US
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Telephone | 864-557-1674
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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 | LC200002192
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License Number State | DC
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