MEDICARE: NICOLE SOBH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1447904289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICOLE SOBH THERAPY LLC

Provider Business Mailing Address
First Line	:	330 S LAFAYETTE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1316
Country	:	US
Telephone Number	:	734-655-0051
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 S LAFAYETTE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-1316
Country	:	US
Telephone Number	:	313-969-3705
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MRS. NICOLE MARIE SOBH
Credential	:	LMSW
Telephone Number	:	313-969-3705

Provider Enumeration Date	:	02/10/2022
Last Update Date	:	04/19/2025

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