Individual
TRACY NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5300 BRICKLEBERRY WAY, SUITE 103, DOUGLASVILLE, GA 30134-4066
(678) 886-0999
Mailing address
5300 BRICKLEBERRY WAY, SUITE 103, DOUGLASVILLE, GA 30134-4066
(678) 886-0999
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
11102014
GA
Other
Enumeration date
03/09/2015
Last updated
07/15/2020
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