Provider Demographics
NPI:1851835094
Name:POPE, NADINE (LCSW)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:POPE
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 1:5965 PARKWAY NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1430
Mailing Address - Country:US
Mailing Address - Phone:770-886-5700
Mailing Address - Fax:770-886-0404
Practice Address - Street 1:5965 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1430
Practice Address - Country:US
Practice Address - Phone:770-886-5700
Practice Address - Fax:770-886-0404
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW005889101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health