Provider Demographics
NPI:1609468735
Name:NASH, MISTY BLUE KIRKLAND (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:BLUE KIRKLAND
Last Name:NASH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MISTY
Other - Middle Name:BLUE
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 BAYMEADOWS DR W
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535-6702
Mailing Address - Country:US
Mailing Address - Phone:912-381-4133
Mailing Address - Fax:
Practice Address - Street 1:408 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2002
Practice Address - Country:US
Practice Address - Phone:912-292-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW005752104100000X
GACSW0082381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker