1689759706 NPI number — MS. NICOLE ALDRED LMFT

Table of content: MS. NICOLE ALDRED LMFT (NPI 1689759706)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689759706 NPI number — MS. NICOLE ALDRED LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALDRED
Provider First Name:
NICOLE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689759706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1830 WATER PL SE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-7407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-916-9031
Provider Business Mailing Address Fax Number:
770-916-9030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 CENTERVIEW DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-370-4228
Provider Business Practice Location Address Fax Number:
615-370-4220
Provider Enumeration Date:
10/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFT1066 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 558804929D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 558804929B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 558804929C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".