Provider Demographics
NPI:1003673302
Name:POPHAM, NATHAN EDWARD (LCSW, LICSW)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:EDWARD
Last Name:POPHAM
Suffix:
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:FRUITHURST
Mailing Address - State:AL
Mailing Address - Zip Code:36262-3751
Mailing Address - Country:US
Mailing Address - Phone:256-926-8797
Mailing Address - Fax:
Practice Address - Street 1:308 3RD ST E
Practice Address - Street 2:
Practice Address - City:FRUITHURST
Practice Address - State:AL
Practice Address - Zip Code:36262-3751
Practice Address - Country:US
Practice Address - Phone:256-926-8797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0074891041C0700X
AL4618C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical