Provider Demographics
NPI:1114719028
Name:NICHOLS, KATHRON (QMHP)
Entity type:Individual
Prefix:
First Name:KATHRON
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 GLADIOLA CRES
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2305
Mailing Address - Country:US
Mailing Address - Phone:757-635-6573
Mailing Address - Fax:757-689-4865
Practice Address - Street 1:5301 ROBIN HOOD RD STE 108
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-2419
Practice Address - Country:US
Practice Address - Phone:757-792-5190
Practice Address - Fax:757-792-5231
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732006435101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health