Provider Demographics
NPI:1629144175
Name:NICHOLS, CHERYL ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LEE DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4953
Mailing Address - Country:US
Mailing Address - Phone:225-767-8570
Mailing Address - Fax:225-767-8572
Practice Address - Street 1:172 LEE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4953
Practice Address - Country:US
Practice Address - Phone:225-767-8570
Practice Address - Fax:225-767-8572
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA36471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5X321Medicare UPIN