Healthcare Provider Details

I. General information

NPI: 1710371828
Provider Name (Legal Business Name): NICHOLE ADRIANA CHAPIN LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE ADRIANA BRYANT LMSW

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W JACKSON BLVD APT 13
JONESBOROUGH TN
37659-1150
US

IV. Provider business mailing address

P.O. BOX 4000
MOUNTAIN HOME TN
37684
US

V. Phone/Fax

Practice location:
  • Phone: 865-322-1590
  • Fax:
Mailing address:
  • Phone: 865-322-1590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4255C
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: