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General NPI Number Information
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NPI Number | 1033561436
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Entity Type | Individual
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Provider Name | NIKIKI STOVALL LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2016
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Last Update Date | 02/02/2019
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Provider Practice Location Address
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Address Line | 405 GAINES SCHOOL RD STE C4
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City | ATHENS
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State | GA
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Zip | 30605-3101
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Country | US
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Telephone | 706-389-9855
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Fax |
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Provider Business Mailing Address
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Address Line | 700 ATHENS RD
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City | WINTERVILLE
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State | GA
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Zip | 30683-1537
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Country | US
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Telephone | 803-397-7088
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C010972
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006552
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License Number State | GA
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