Provider Demographics
NPI:1538998612
Name:NICHOLSON, REGINA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 KEVIN PL
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43610-1561
Mailing Address - Country:US
Mailing Address - Phone:318-381-4243
Mailing Address - Fax:
Practice Address - Street 1:12677 TALL TIMBER CIR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3711
Practice Address - Country:US
Practice Address - Phone:216-562-7214
Practice Address - Fax:440-457-7088
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health