Basic Information
| Provider Information | |||||||||
| NPI: | 1942754619 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | CASEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | BSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 20TH ST S | ||||||||
| Address2: | 4TH FLOOR RM 479 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352052610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059349715 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UAB COMMUNITY PSYCHIATRY | ||||||||
| Address2: | 908 20TH STREET SOUTH RM 479 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352940001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059349715 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2016 | ||||||||
| LastUpdateDate: | 08/10/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.