MEDICARE: RODNEY DUPREE NICHOLS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1033435938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RODNEY DUPREE NICHOLS

Provider Business Mailing Address
First Line	:	926 E 49TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-4104
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 E 49TH PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-4104
Country	:	US
Telephone Number	:	888-417-5163
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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