Provider Demographics
NPI:1558516328
Name:NOACK, OLIVIA JEAN (LMSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:OLIVIA
Middle Name:JEAN
Last Name:NOACK
Suffix:
Gender:M
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 E 24TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4973
Mailing Address - Country:US
Mailing Address - Phone:616-393-9282
Mailing Address - Fax:
Practice Address - Street 1:217 E 24TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4973
Practice Address - Country:US
Practice Address - Phone:616-393-9282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010713431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI157892OtherVALUE OPTIONS, INC.