Provider Demographics
NPI:1295160166
Name:NICHOLS, AMBER C (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:C
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 1:7527 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-4416
Mailing Address - Country:US
Mailing Address - Phone:865-235-5741
Mailing Address - Fax:
Practice Address - Street 1:10820 KINGSTON PIKE STE 4
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-3065
Practice Address - Country:US
Practice Address - Phone:865-201-8112
Practice Address - Fax:865-297-4221
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
TN67891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker