1720768179 NPI number — NICHELLE RENEE MCDANIEL FLOWERS MA, LPC

Table of content: NICHELLE RENEE MCDANIEL FLOWERS MA, LPC (NPI 1720768179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720768179 NPI number — NICHELLE RENEE MCDANIEL FLOWERS MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL FLOWERS
Provider First Name:
NICHELLE
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FLOWERS
Provider Other First Name:
RENEE
Provider Other Middle Name:
MCDANIEL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720768179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 W SPRINGBROOK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADWAY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22815-9527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-671-6817
Provider Business Mailing Address Fax Number:
540-896-7687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 W SPRINGBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROADWAY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22815-9527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-671-6817
Provider Business Practice Location Address Fax Number:
540-896-7687
Provider Enumeration Date:
07/20/2023

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: 101YP2500X , with the licence number:  0701012697 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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