Provider Demographics
NPI:1144823352
Name:NIKOLAKOPOULOS, ETHEL (LCSW)
Entity type:Individual
Prefix:
First Name:ETHEL
Middle Name:
Last Name:NIKOLAKOPOULOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5404
Mailing Address - Country:US
Mailing Address - Phone:925-602-6150
Mailing Address - Fax:
Practice Address - Street 1:2900 AVON AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5404
Practice Address - Country:US
Practice Address - Phone:925-602-6150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA853171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA85317OtherLICENSE CLINICAL SOCIAL WORKER