Basic Information
| Provider Information | |||||||||
| NPI: | 1407935455 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | HATTIE | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1031 E SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489065519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5174879642 | ||||||||
| FaxNumber: | 5174871129 | ||||||||
| Practice Location | |||||||||
| Address1: | 5030 NORTHWIND DR STE 108 | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488235034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173364335 | ||||||||
| FaxNumber: | 5173360101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 05/07/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801079885 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.