Provider Demographics
NPI:1578233805
Name:NICHOLS, DANIELLE KIZZIAH (LMSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:KIZZIAH
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:HOPE
Other - Last Name:KIZZIAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 OLIVIA CIR
Mailing Address - Street 2:
Mailing Address - City:LOUDON
Mailing Address - State:TN
Mailing Address - Zip Code:37774-5800
Mailing Address - Country:US
Mailing Address - Phone:865-314-3211
Mailing Address - Fax:
Practice Address - Street 1:1320 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-2418
Practice Address - Country:US
Practice Address - Phone:423-746-1405
Practice Address - Fax:423-745-6413
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-17
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000012831104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker