Provider Demographics
NPI:1275304669
Name:DUCKWYLER-TUCKER, NICOLE MICHELE (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MICHELE
Last Name:DUCKWYLER-TUCKER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:MICHELE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLMSW
Mailing Address - Street 1:707 W MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2943
Mailing Address - Country:US
Mailing Address - Phone:313-833-2500
Mailing Address - Fax:313-833-2156
Practice Address - Street 1:707 W MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2943
Practice Address - Country:US
Practice Address - Phone:313-833-2500
Practice Address - Fax:313-833-2156
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511101201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty