Provider Demographics
NPI:1710371828
Name:CHAPIN, NICHOLE ADRIANA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:ADRIANA
Last Name:CHAPIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:NICHOLE
Other - Middle Name:ADRIANA
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:P.O. BOX 4000
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:865-322-1590
Mailing Address - Fax:
Practice Address - Street 1:420 W JACKSON BLVD
Practice Address - Street 2:APT 13
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1150
Practice Address - Country:US
Practice Address - Phone:865-322-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4255C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical