Provider Demographics
NPI:1689759706
Name:ALDRED, NICOLE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:ALDRED
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 WATER PL SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-7407
Mailing Address - Country:US
Mailing Address - Phone:770-916-9031
Mailing Address - Fax:770-916-9030
Practice Address - Street 1:215 CENTERVIEW DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5246
Practice Address - Country:US
Practice Address - Phone:615-370-4228
Practice Address - Fax:615-370-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT1066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA558804929DMedicaid
GA558804929BMedicaid
GA558804929CMedicaid