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General NPI Number Information
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NPI Number | 1053928507
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Entity Type | Organization
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Legal Business Name | THERAPY WITH NICOLE PLLC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 4867 E. BELTLINE AVE. NE BUILDING #1 LOWER LEVEL
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City | GRAND RAPIDS
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State | MI
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Zip | 49525
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Country | US
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Telephone | 616-258-0147
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Fax |
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Provider Business Mailing Address
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Address Line | 4755 HIDDEN HIGHLAND DR NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7376
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Country | US
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Telephone | 616-204-7534
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Fax |
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Authorized Official
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Title or Position | OWNER/CLINICIAN
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Name | NICOLE VEGA
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Credential | LMSW
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Telephone | 616-258-0147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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