Provider Demographics
NPI:1770998189
Name:NICHOLS, MARY ANN (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1568
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1568
Mailing Address - Country:US
Mailing Address - Phone:256-270-9483
Mailing Address - Fax:256-325-0340
Practice Address - Street 1:190 LIME QUARRY RD
Practice Address - Street 2:STE #115
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8962
Practice Address - Country:US
Practice Address - Phone:256-270-9483
Practice Address - Fax:256-325-0340
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional