Individual
LILLIE NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2333 MARTIN AVE, BATON ROUGE, LA 70802-1431
(225) 205-9810
(225) 612-6347
Mailing address
2333 MARTIN AVE, BATON ROUGE, LA 70802-1431
(225) 205-9810
(225) 612-6347
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
LA
Enumeration date
09/09/2016
Last updated
09/09/2016
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