Healthcare Provider Details

I. General information

NPI: 1184863250
Provider Name (Legal Business Name): NICHELL ANTOINETTE TERRELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S BROAD ST
NEW ORLEANS LA
70119-7410
US

IV. Provider business mailing address

1525 ADAMS ST
NEW ORLEANS LA
70118-4001
US

V. Phone/Fax

Practice location:
  • Phone: 504-827-2928
  • Fax:
Mailing address:
  • Phone: 504-865-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number9479
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number9479
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: