Healthcare Provider Details

I. General information

NPI: 1447173406
Provider Name (Legal Business Name): NICKIE L MANIER LADAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 NEW HIGHWAY 96 W STE 102
FRANKLIN TN
37064-2545
US

IV. Provider business mailing address

269 BUNKER HILL LN
ROCKVALE TN
37153-8516
US

V. Phone/Fax

Practice location:
  • Phone: 615-914-7057
  • Fax:
Mailing address:
  • Phone: 615-801-7052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1697
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: