Provider Demographics
NPI:1669366597
Name:NICHOLS, COURTNEY LACE ANNE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LACE ANNE
Last Name:NICHOLS
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 1:158 MEADOWWOOD LN APT 70
Mailing Address - Street 2:
Mailing Address - City:CHESANING
Mailing Address - State:MI
Mailing Address - Zip Code:48616-1176
Mailing Address - Country:US
Mailing Address - Phone:810-287-1204
Mailing Address - Fax:
Practice Address - Street 1:211 N SHIAWASSEE ST STE A
Practice Address - Street 2:
Practice Address - City:CORUNNA
Practice Address - State:MI
Practice Address - Zip Code:48817-1444
Practice Address - Country:US
Practice Address - Phone:989-928-3566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty