Provider Demographics
NPI:1225681307
Name:REEVES, NICOLE BERNICE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:BERNICE
Last Name:REEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 DOUGLAS ST APT 410D
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-4340
Mailing Address - Country:US
Mailing Address - Phone:615-631-4091
Mailing Address - Fax:
Practice Address - Street 1:301 WOLVERINE TRL STE 200
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-5656
Practice Address - Country:US
Practice Address - Phone:615-751-0579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN14998104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health