Amanda Nicole Nicholson, PHD, LMFT, ME.D.

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MFT001741 Issued in GA

Practice address

269 Highway 138 SW Apt 902
Riverdale, GA 30274-4064

Phone

(678) 549-4263

NPI assigned

Jun 9, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591660800000",
    "number": "1205451960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 HIGHWAY 138 SW APT 902",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744064",
            "telephone_number": "678-549-4263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 HIGHWAY 138 SW APT 902",
            "city": "RIVERDALE",
            "state": "GA",
            "postal_code": "302744064",
            "telephone_number": "678-549-4263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "AMANDA",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PHD, LMFT,  ME.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "GA",
            "license": "MFT001741",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Riverdale, GA
• Providers in Riverdale, GA by specialty
• Marriage & Family Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.