Provider Demographics
NPI:1194466706
Name:MIKEL, NOKALETA (LLMSW)
Entity Type:Individual
Prefix:
First Name:NOKALETA
Middle Name:
Last Name:MIKEL
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19536 SHADY LANE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1630
Mailing Address - Country:US
Mailing Address - Phone:313-402-9212
Mailing Address - Fax:
Practice Address - Street 1:19536 SHADY LANE AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1630
Practice Address - Country:US
Practice Address - Phone:313-402-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851097923104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker