Provider Demographics
NPI:1487746376
Name:ZIMMERMAN, CLAIRE NICHOLS (LCSW)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:NICHOLS
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:ALEXIS
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:523 1/2 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-2450
Mailing Address - Country:US
Mailing Address - Phone:706-425-8900
Mailing Address - Fax:706-425-8600
Practice Address - Street 1:523 1/2 PRINCE AVENUE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-2450
Practice Address - Country:US
Practice Address - Phone:706-425-8900
Practice Address - Fax:706-425-8600
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0030181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP43871Medicare UPIN
GA80BBFMPMedicare ID - Type Unspecified