1205881372 NPI number — DEBORA SUE NICHOLS LPC

Table of content: DEBORA SUE NICHOLS LPC (NPI 1205881372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205881372 NPI number — DEBORA SUE NICHOLS LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
DEBORA
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICHOLS
Provider Other First Name:
DEBORA
Provider Other Middle Name:
HILL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1205881372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29319 LAKEVIEW DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARDMORE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-585-0222
Provider Business Mailing Address Fax Number:
256-423-7177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26670 5TH STREET
Provider Second Line Business Practice Location Address:
FIRST BAPTIST CHURCH
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-585-0222
Provider Business Practice Location Address Fax Number:
256-423-7177
Provider Enumeration Date:
05/24/2006

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: 101Y00000X , with the licence number:  1551 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 51524370 . This is a "BCBS" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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