Provider Demographics
NPI:1801250642
Name:SIEMERS, NICHOLAS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:SIEMERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 ASHLEY RIVER RD
Mailing Address - Street 2:APT. 5A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6385
Mailing Address - Country:US
Mailing Address - Phone:843-697-6860
Mailing Address - Fax:
Practice Address - Street 1:1385 ASHLEY RIVER RD
Practice Address - Street 2:APT. 5A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6385
Practice Address - Country:US
Practice Address - Phone:843-697-6860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-07
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst