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 1:47 GREEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-4368
Mailing Address - Country:US
Mailing Address - Phone:770-490-6055
Mailing Address - Fax:
Practice Address - Street 1:9238 MADISON BLVD STE 835
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-9101
Practice Address - Country:US
Practice Address - Phone:256-487-7948
Practice Address - Fax:256-427-2871
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional