Provider Demographics
NPI:1912056250
Name:FLORES, NICOLE EILEEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:EILEEN
Last Name:FLORES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:EILEEN
Other - Last Name:MARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3440 MAHOPAC DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48360-1526
Mailing Address - Country:US
Mailing Address - Phone:248-891-7379
Mailing Address - Fax:
Practice Address - Street 1:3440 MAHOPAC DR
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48360-1526
Practice Address - Country:US
Practice Address - Phone:248-891-7379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010865141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical