Provider Demographics
NPI:1861610594
Name:NICHOLS, BRENT H (LPC)
Entity type:Individual
Prefix:MR
First Name:BRENT
Middle Name:H
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 LEE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-7132
Mailing Address - Country:US
Mailing Address - Phone:912-262-6080
Mailing Address - Fax:912-261-0593
Practice Address - Street 1:1421 LEE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-7132
Practice Address - Country:US
Practice Address - Phone:912-262-6080
Practice Address - Fax:912-261-0593
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1673101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor