Healthcare Provider Details

I. General information

NPI: 1225705643
Provider Name (Legal Business Name): NICOLE NUWAYHID LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SUN TEMPLE DR
MADISON AL
35758-8621
US

IV. Provider business mailing address

240 IVYLEAF DR NW
MADISON AL
35757-5901
US

V. Phone/Fax

Practice location:
  • Phone: 256-503-2171
  • Fax:
Mailing address:
  • Phone: 256-503-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4800C
License Number StateAL

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: