Provider Demographics
NPI:1518610104
Name:DUECK, HOLLI-NOELLE (LLPC)
Entity Type:Individual
Prefix:
First Name:HOLLI-NOELLE
Middle Name:
Last Name:DUECK
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 1:3201 BURTON ST SE # TAU01
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-4301
Mailing Address - Country:US
Mailing Address - Phone:616-813-6013
Mailing Address - Fax:
Practice Address - Street 1:4867 EAST BELTLINE AVE NE
Practice Address - Street 2:BUILDING #1
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4952
Practice Address - Country:US
Practice Address - Phone:616-813-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451020901101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty