Provider Demographics
NPI:1336715986
Name:MYERS, NADINE NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:NICOLE
Last Name:MYERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 HEMINGWAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7030
Mailing Address - Country:US
Mailing Address - Phone:919-436-5963
Mailing Address - Fax:
Practice Address - Street 1:2134 HEMINGWAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7030
Practice Address - Country:US
Practice Address - Phone:919-436-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006401104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker