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1033535364
BROOKE LANE NICHOLS
SANTA ROSA, CA
NPI
1033535364
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Former Name
BROOKE LANE TYRWHITT
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2014-03-11
Last Update Date
2019-03-29
Business Address
BROOKE LANE NICHOLS
2403 PROFESSIONAL DR
SANTA ROSA, CA 95403-3007
Phone number: 707-544-3295
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Mailing Address
BROOKE LANE NICHOLS
2403 PROFESSIONAL DR
SANTA ROSA, CA 95403-3007
Phone number: 707-544-3295
Copy
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