Healthcare Provider Details

I. General information

NPI: 1316859846
Provider Name (Legal Business Name): NICOLE ELIZABETH HUBER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1195 PORT SHELDON ST
GEORGETOWN TOWNSHIP MI
49428-9341
US

IV. Provider business mailing address

1195 PORT SHELDON ST
GEORGETOWN TOWNSHIP MI
49428-9341
US

V. Phone/Fax

Practice location:
  • Phone: 616-457-2200
  • Fax:
Mailing address:
  • Phone: 616-457-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851121570
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: