Provider Demographics
NPI:1821870429
Name:ONICKEL, ROSLYN H (LLC)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:H
Last Name:ONICKEL
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 S WASHINGTON AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-3833
Mailing Address - Country:US
Mailing Address - Phone:248-581-4659
Mailing Address - Fax:
Practice Address - Street 1:306 S WASHINGTON AVE STE 205
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-3833
Practice Address - Country:US
Practice Address - Phone:248-581-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451023265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional