Healthcare Provider Details

I. General information

NPI: 1366181679
Provider Name (Legal Business Name): NIKELI SHARELL REEVES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NIKELI JACKSON INTERN LCSW

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 FORTNER ST STE 6
DOTHAN AL
36301-2412
US

IV. Provider business mailing address

1605 SQUIRE CT
DOTHAN AL
36301-4026
US

V. Phone/Fax

Practice location:
  • Phone: 334-791-1661
  • Fax:
Mailing address:
  • Phone: 113-347-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW15704
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: