Provider Demographics
NPI:1306037403
Name:CARR, NICHOLE JENNIFER (LISW-S)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:JENNIFER
Last Name:CARR
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:JENNIFER
Other - Last Name:DUDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:867 DUFOUR LN
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8514
Mailing Address - Country:US
Mailing Address - Phone:765-914-9986
Mailing Address - Fax:
Practice Address - Street 1:867 DUFOUR LN
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8514
Practice Address - Country:US
Practice Address - Phone:765-914-9986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006156A1041C0700X
OHI.1700654-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical