Provider Demographics
NPI:1336106129
Name:COTTER, NOELLE KATHRYN (MSW)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:KATHRYN
Last Name:COTTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:
Other - Last Name:DAUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8757 COOLEY BEACH DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386
Mailing Address - Country:US
Mailing Address - Phone:248-760-0827
Mailing Address - Fax:
Practice Address - Street 1:1322 N RIVER RD
Practice Address - Street 2:NORSERV GROUP
Practice Address - City:ST CLAIR
Practice Address - State:MI
Practice Address - Zip Code:48079
Practice Address - Country:US
Practice Address - Phone:810-329-4798
Practice Address - Fax:810-329-7303
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010813141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI740123Medicaid
MI740123Medicaid