Provider Information for 1417628777
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Ms. CASEREA NIKKOL TOWNSEND LPC
Sex: Female
NPI: 1417628777
Last Updated: 2021-10-16
Certification Date: 2021-10-16
Certification Date: 2021-10-16
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417628777 | ||||||||||||
| Enumeration Date | 2021-09-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 215 LAKEWAY DR WAXAHACHIE, TX 75165-6814 United States Phone: 901-207-0223 | Fax: | ||||||||||||
| Primary Practice Address | 215 LAKEWAY DR WAXAHACHIE, TX 75165-6814 United States Phone: 901-207-0223 | Fax: | ||||||||||||
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