Provider Demographics
NPI:1881102945
Name:HOLBROOK, NICOLE ANNE (LMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:HOLBROOK
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 1:640 3 MILE RD NW STE G
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8209
Mailing Address - Country:US
Mailing Address - Phone:517-234-3826
Mailing Address - Fax:
Practice Address - Street 1:1717 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4529
Practice Address - Country:US
Practice Address - Phone:517-372-4700
Practice Address - Fax:517-372-3314
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI101YA0400X
MI6801106651104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)