Provider Demographics
NPI:1831896042
Name:NICHOLS, AUTUMN (MSW)
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 KITSAP WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-2357
Mailing Address - Country:US
Mailing Address - Phone:360-373-2536
Mailing Address - Fax:
Practice Address - Street 1:4660 KITSAP WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-2357
Practice Address - Country:US
Practice Address - Phone:360-373-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker