Healthcare Provider Details

I. General information

NPI: 1659142206
Provider Name (Legal Business Name): NOELLE HARB WYLIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NOELLE HARB LLMSW

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 INDUSTRIAL DR STE 1
SALINE MI
48176-1742
US

IV. Provider business mailing address

16854 COUNTRY CLUB DR
LIVONIA MI
48154-2174
US

V. Phone/Fax

Practice location:
  • Phone: 313-719-6779
  • Fax:
Mailing address:
  • Phone: 313-719-6779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801114740
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: