Provider Demographics
NPI:1023232626
Name:NICHOLSON, SUSAN CUMMINGS (PHD, LCSW, BCD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:CUMMINGS
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PHD, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 WOODBURNE LN
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-8363
Mailing Address - Country:US
Mailing Address - Phone:757-869-2361
Mailing Address - Fax:757-223-1165
Practice Address - Street 1:703 THIMBLE SHOALS BLVD
Practice Address - Street 2:A-3
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2576
Practice Address - Country:US
Practice Address - Phone:757-873-3401
Practice Address - Fax:757-223-1165
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040030481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical