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General NPI Number Information
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NPI Number | 1154935468
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Entity Type | Individual
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Provider Name | NICK HERSEY LMFT, LPC
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Gender | Male
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 1924 CLAIRMONT RD STE 50
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City | DECATUR
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State | GA
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Zip | 30033-3450
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Country | US
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Telephone | 404-977-8814
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 983
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City | CLARKSTON
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State | GA
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Zip | 30021-0983
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC009382
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT001493
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License Number State | GA
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