Provider Demographics
NPI:1548673387
Name:NICHOLSEN, JASON (LICSW)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:NICHOLSEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 20TH ST NE
Mailing Address - Street 2:#1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-6752
Mailing Address - Country:US
Mailing Address - Phone:347-834-3781
Mailing Address - Fax:
Practice Address - Street 1:2301 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:WHITMAN WALKER HEALTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5813
Practice Address - Country:US
Practice Address - Phone:347-834-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50081076104100000X
DCLC500809581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker