Provider Demographics
NPI:1245712264
Name:FALCONER, NICOLE LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:FALCONER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:314 CRESCENT ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3302
Mailing Address - Country:US
Mailing Address - Phone:231-903-9114
Mailing Address - Fax:231-724-6047
Practice Address - Street 1:376 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3466
Practice Address - Country:US
Practice Address - Phone:231-903-9114
Practice Address - Fax:231-724-6047
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010968851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical