Individual
JODY NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
806 CARTER ST, VIDALIA, LA 71373-3206
(318) 734-0034
(601) 493-5898
Mailing address
806 CARTER ST, VIDALIA, LA 71373-3206
(318) 734-0034
(601) 493-5898
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
CIT-5033
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5033
STATE OF LOUISIANA ADDICTIVE DISORDER REGULATORY AUTHORITY
LA
Enumeration date
09/20/2019
Last updated
02/04/2021
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