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General NPI Number Information
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NPI Number | 1962966879
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Entity Type | Individual
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Provider Name | TUESDAE NICHOL LAWRENCE MMFT
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Gender | Female
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Dates
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Enumeration Date | 01/24/2019
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 2395 LOUPIN DR APT 71A
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City | CLARKSVILLE
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State | TN
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Zip | 37042-0911
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Country | US
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Telephone | 615-823-8254
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Fax |
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Provider Business Mailing Address
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Address Line | 260 HUGH SHELTON LOOP
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-3485
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Country | US
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Telephone | 404-513-9207
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1433
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License Number State | TN
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