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General NPI Number Information
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NPI Number | 1629391651
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Entity Type | Individual
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Provider Name | NICOLE D TACOMA PSY.D, LP
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Gender | Female
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Dates
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Enumeration Date | 03/04/2010
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 17282 FARMINGTON RD
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City | LIVONIA
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State | MI
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Zip | 48152-3151
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Country | US
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Telephone | 248-987-0654
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Fax | 248-530-4325
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Provider Business Mailing Address
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Address Line | 4069 HARBOR VISTA DR
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City | ORCHARD LAKE
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State | MI
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Zip | 48323-1617
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301014882
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License Number State | MI
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