Organization
NICHOLS COUNSELING SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY NICHOLS (OWNER)
(678) 886-0999
Entity
Organization
Contact information
Practice address
5300 BRICKLEBERRY WAY STE 206, DOUGLASVILLE, GA 30134-4068
(678) 886-0999
(770) 485-1821
Mailing address
5300 BRICKLEBERRY WAY STE 206, DOUGLASVILLE, GA 30134-4068
(678) 886-0999
(770) 485-1821
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003239367A
—
GA
Enumeration date
03/10/2021
Last updated
03/10/2021
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