Basic Information
| Provider Information | |||||||||
| NPI: | 1477923324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUNLAP | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1302 HEATHCLIFF DR | ||||||||
| Address2: | |||||||||
| City: | HILLSDALE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492421536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172008063 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 W MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177877920 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 12/07/2015 | ||||||||
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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 | 1041C0700X | 6801098439 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.