Provider Demographics
NPI:1790780906
Name:NICHOLS, CLAUDIA SORRELLS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CLAUDIA
Middle Name:SORRELLS
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 1:5950 WOLFGANG DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8750
Mailing Address - Country:US
Mailing Address - Phone:334-447-9623
Mailing Address - Fax:
Practice Address - Street 1:5950 WOLFGANG DR
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8750
Practice Address - Country:US
Practice Address - Phone:334-447-9623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW72941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW7294OtherLICENSE PRACTICE NUMBER