Provider Demographics
NPI:1659142206
Name:WYLIN, NOELLE HARB (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NOELLE
Middle Name:HARB
Last Name:WYLIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:NOELLE
Other - Middle Name:
Other - Last Name:HARB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:16854 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-2174
Mailing Address - Country:US
Mailing Address - Phone:313-719-6779
Mailing Address - Fax:
Practice Address - Street 1:1235 INDUSTRIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1742
Practice Address - Country:US
Practice Address - Phone:313-719-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011147401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical