Individual
LYSSA NICKLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
3021 SCHROER DR, VALDOSTA, GA 31602-4067
(229) 630-2499
Mailing address
3021 SCHROER DR, VALDOSTA, GA 31602-4067
(229) 630-2499
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW004376
GA
Other
Enumeration date
03/02/2015
Last updated
03/02/2015
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