Provider Demographics
NPI:1669863510
Name:NICHOLAS J PAPPAS, LCSW, LLC
Entity Type:Organization
Organization Name:NICHOLAS J PAPPAS, LCSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:DUMELOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-626-4629
Mailing Address - Street 1:PO BOX 1731
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1731
Mailing Address - Country:US
Mailing Address - Phone:251-626-4629
Mailing Address - Fax:251-621-0253
Practice Address - Street 1:900 WESTERN AMERICA CIR STE 211
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4102
Practice Address - Country:US
Practice Address - Phone:251-454-6108
Practice Address - Fax:251-626-2897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0144C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL34771Medicare PIN