Provider Demographics
NPI:1003353574
Name:PILLAR, NICOLE MARIE (MA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PILLAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:PASDERTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:241 HIGHWAY 641 N STE A
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1393
Mailing Address - Country:US
Mailing Address - Phone:731-213-2214
Mailing Address - Fax:731-213-2237
Practice Address - Street 1:5118 PARK AVE STE 500
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-5713
Practice Address - Country:US
Practice Address - Phone:901-458-8638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health