Provider Demographics
NPI:1346026275
Name:DECKER, NICOLE SHEARON
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SHEARON
Last Name:DECKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N HIGHLAND AVE NE APT 137
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4651
Mailing Address - Country:US
Mailing Address - Phone:770-315-4524
Mailing Address - Fax:
Practice Address - Street 1:4045 ORCHARD RD SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-4902
Practice Address - Country:US
Practice Address - Phone:770-293-1950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health