Provider Demographics
NPI:1770630279
Name:NICHOLS, ALICE S (LCSW)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:S
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 1:354 COOL SPRINGS BLVD
Mailing Address - Street 2:105
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7252
Mailing Address - Country:US
Mailing Address - Phone:615-584-8468
Mailing Address - Fax:615-771-1109
Practice Address - Street 1:354 COOL SPRINGS BLVD
Practice Address - Street 2:105
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-7252
Practice Address - Country:US
Practice Address - Phone:615-584-8468
Practice Address - Fax:615-771-1109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3690143Medicare ID - Type Unspecified