Provider Demographics
NPI:1205881372
Name:NICHOLS, DEBORA SUE (LPC)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:SUE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:HILL
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:29319 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:AL
Mailing Address - Zip Code:35739
Mailing Address - Country:US
Mailing Address - Phone:256-585-0222
Mailing Address - Fax:256-423-7177
Practice Address - Street 1:26670 5TH STREET
Practice Address - Street 2:FIRST BAPTIST CHURCH
Practice Address - City:ARDMORE
Practice Address - State:AL
Practice Address - Zip Code:35739
Practice Address - Country:US
Practice Address - Phone:256-585-0222
Practice Address - Fax:256-423-7177
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1551101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51524370OtherBCBS