1710371828 NPI number — MS. NICHOLE ADRIANA CHAPIN LICSW

Table of content: MS. NICHOLE ADRIANA CHAPIN LICSW (NPI 1710371828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710371828 NPI number — MS. NICHOLE ADRIANA CHAPIN LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPIN
Provider First Name:
NICHOLE
Provider Middle Name:
ADRIANA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRYANT
Provider Other First Name:
NICHOLE
Provider Other Middle Name:
ADRIANA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710371828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 4000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTAIN HOME
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-322-1590
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 W JACKSON BLVD
Provider Second Line Business Practice Location Address:
APT 13
Provider Business Practice Location Address City Name:
JONESBOROUGH
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37659-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-322-1590
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2015

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: 1041C0700X , with the licence number:  4255C , 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)





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