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General NPI Number Information
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NPI Number | 1902532138
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Entity Type | Individual
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Provider Name | NICHOLE CHARLENE RADER LPC
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Gender | Female
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 04/18/2023
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Provider Practice Location Address
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Address Line | 4039 GATEWAY BLVD
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City | GROVETOWN
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State | GA
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Zip | 30813-3389
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Country | US
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Telephone | 719-684-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 321 CONNOR CIR
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City | EVANS
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State | GA
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Zip | 30809-6137
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC013785
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License Number State | GA
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