Provider Demographics
NPI:1558894550
Name:GALES, NICOLE EVA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:EVA
Last Name:GALES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:EVA
Other - Last Name:HOLLOMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:418 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4314
Mailing Address - Country:US
Mailing Address - Phone:601-653-0936
Mailing Address - Fax:601-659-4248
Practice Address - Street 1:418 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4314
Practice Address - Country:US
Practice Address - Phone:601-653-0936
Practice Address - Fax:601-659-4248
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS193200000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker