Healthcare Provider Details

I. General information

NPI: 1346471430
Provider Name (Legal Business Name): NICOLE C WALSH LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E STATE ST
STERLING MI
48659-9548
US

IV. Provider business mailing address

725 E STATE ST
STERLING MI
48659-9548
US

V. Phone/Fax

Practice location:
  • Phone: 989-654-2491
  • Fax: 989-654-2190
Mailing address:
  • Phone: 989-654-2491
  • Fax: 989-654-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: