Provider Demographics
NPI:1225227929
Name:PARKER, NICOLE ALETHA (LLMSW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALETHA
Last Name:PARKER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ALETHA
Other - Last Name:GASKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:28 N SAGINAW ST
Mailing Address - Street 2:SUITE 813
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-2134
Mailing Address - Country:US
Mailing Address - Phone:248-451-0540
Mailing Address - Fax:248-451-0544
Practice Address - Street 1:28 N SAGINAW ST
Practice Address - Street 2:SUITE 813
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-2134
Practice Address - Country:US
Practice Address - Phone:248-451-0540
Practice Address - Fax:248-451-0544
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010895331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical