Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103G00000X | Clinical Psychologist | PSY22648 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22648 | CA |
NPI | 1003016197 |
---|---|
Provider Name | Dr. Christopher G Nikolaidis |
First Address | Newport Beach, CA 92660-7506 |
Second Address | Newport Beach, CA 92660-7506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 25/02/2012 |