Provider Demographics
NPI:1942561147
Name:CHRISTIAN, NICOLE C (PHD)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:C
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:C
Other - Last Name:STYPEREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX 282
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162
Mailing Address - Country:US
Mailing Address - Phone:706-237-6195
Mailing Address - Fax:706-237-6281
Practice Address - Street 1:305 REDMOND RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165
Practice Address - Country:US
Practice Address - Phone:706-237-6195
Practice Address - Fax:706-237-6281
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003542103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist