Provider Demographics
NPI:1881933497
Name:NICHOLS, CHARLES RICHARD (LPC)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MARTIN LUTHER KING JR. DR.
Mailing Address - Street 2:SUITE 450-A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30310
Mailing Address - Country:US
Mailing Address - Phone:404-551-5654
Mailing Address - Fax:404-551-5570
Practice Address - Street 1:2001 MARTIN LUTHER KING JR. DR.
Practice Address - Street 2:SUITE 450-A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30310
Practice Address - Country:US
Practice Address - Phone:404-551-5654
Practice Address - Fax:404-551-5570
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional