Provider Demographics
NPI:1336434158
Name:CHAVOUS, NINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:
Last Name:CHAVOUS
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 1:777 UNDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRION
Mailing Address - State:GA
Mailing Address - Zip Code:30753-1500
Mailing Address - Country:US
Mailing Address - Phone:706-857-0482
Mailing Address - Fax:
Practice Address - Street 1:777 UNDERWOOD DR
Practice Address - Street 2:
Practice Address - City:TRION
Practice Address - State:GA
Practice Address - Zip Code:30753-1500
Practice Address - Country:US
Practice Address - Phone:706-857-0482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0036191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical