Healthcare Provider Details

I. General information

NPI: 1578233805
Provider Name (Legal Business Name): DANIELLE KIZZIAH NICHOLS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DANIELLE HOPE KIZZIAH

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 DECATUR PIKE
ATHENS TN
37303-2418
US

IV. Provider business mailing address

303 OLIVIA CIR
LOUDON TN
37774-5800
US

V. Phone/Fax

Practice location:
  • Phone: 423-746-1405
  • Fax: 423-745-6413
Mailing address:
  • Phone: 865-314-3211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW0000012831
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: