Basic Information
| Provider Information | |||||||||
| NPI: | 1548461577 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANDERHOFF | ||||||||
| FirstName: | NICHOLE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8075 OGDEN DR | ||||||||
| Address2: | |||||||||
| City: | STERLING HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483143309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487098640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6637 HIGHLAND RD | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483271675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486668870 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801089168 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 6801089168 | 01 | MI | MASTERS LTD SOCIAL WORKER | OTHER |