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NPI Code Detail

MEDICARE: NICOLE HEREIM

MEDICARE: NICOLE HEREIM
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
1103K00000XBehavior Analyst1695NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821548017
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE HEREIM
Provider Business Mailing Address
First Line : 209 7TH ST FL 3
Second Line :
City : AUGUSTA
State : GA
Zip : 30901-1486
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Provider Business Practice Location Address
First Line : 8509 CROWN CRESCENT CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7733
Country : US
Telephone Number : 706-842-5330
Fax Number : 706-842-5340
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2016
Last Update Date : 12/26/2025

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Directions to “ NICOLE HEREIM ” Practice Location

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