Provider Demographics
NPI:1881051845
Name:FALL, NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2785
Mailing Address - Country:US
Mailing Address - Phone:231-881-3970
Mailing Address - Fax:
Practice Address - Street 1:3434 M 119 STE C
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9373
Practice Address - Country:US
Practice Address - Phone:231-348-9900
Practice Address - Fax:989-358-3780
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011157781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical