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1619101847
MICHAEL R NICHOLSON
HALES CORNERS, WI
NPI
1619101847
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: WI 15466-132)
Enumeration Date
2009-05-01
Last Update Date
2016-04-26
Business Address
MR. MICHAEL R NICHOLSON CSAC CSIT
10940 W FOREST HOME AVE
HALES CORNERS, WI 53130-2516
Phone number: 262-278-4462
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Mailing Address
MR. MICHAEL R NICHOLSON CSAC CSIT
1021 N MULFORD RD
ROCKFORD, IL 61107-3877
Phone number: 815-391-5600
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