Provider Demographics
NPI:1609003094
Name:DIVIS, NANCY RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RAE
Last Name:DIVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:RAE
Other - Last Name:PICKERELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:819 WATER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5333
Mailing Address - Country:US
Mailing Address - Phone:830-258-5430
Mailing Address - Fax:830-792-5771
Practice Address - Street 1:819 WATER ST
Practice Address - Street 2:STE 300
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5333
Practice Address - Country:US
Practice Address - Phone:830-258-5430
Practice Address - Fax:830-792-5771
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31800OtherLICENSE