Healthcare Provider Details

I. General information

NPI: 1194599290
Provider Name (Legal Business Name): NICOLE J HOOD LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 WOODMEADOW DR SE
GRAND RAPIDS MI
49546-8031
US

IV. Provider business mailing address

5154 FLAXTON DR APT G5
SAGINAW MI
48603-1820
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-0194
  • Fax:
Mailing address:
  • Phone: 989-522-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851117530
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: