Provider Demographics
NPI:1316356074
Name:DEVOL, NICOLE (LLPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DEVOL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W 11TH ST
Mailing Address - Street 2:#217
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-3287
Mailing Address - Country:US
Mailing Address - Phone:231-409-1276
Mailing Address - Fax:
Practice Address - Street 1:3642 ORCHARD VW
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-8940
Practice Address - Country:US
Practice Address - Phone:231-409-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011969101YM0800X
MIPF0000000783549101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool