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General NPI Number Information
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NPI Number | 1538867809
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Entity Type | Individual
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Provider Name | DANIELLE NICKERSON
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Gender | Female
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Dates
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Enumeration Date | 02/16/2023
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Last Update Date | 03/12/2023
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Provider Practice Location Address
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Address Line | 635 N 12TH ST STE 101
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City | LEMOYNE
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State | PA
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Zip | 17043-1225
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Country | US
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Telephone | 717-585-0627
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Fax |
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Provider Business Mailing Address
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Address Line | 129 E PORTLAND ST
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City | MECHANICSBURG
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State | PA
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Zip | 17055-3333
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Country | US
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Telephone | 215-208-0917
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC015412
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License Number State | PA
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