Provider Demographics
NPI:1104500461
Name:NIKOLE SCOTT LLC
Entity type:Organization
Organization Name:NIKOLE SCOTT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASTER SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKOLE
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DSW, LMSW, CACGS
Authorized Official - Phone:734-716-8461
Mailing Address - Street 1:32541 BERTRAM DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48185-1520
Mailing Address - Country:US
Mailing Address - Phone:734-716-8461
Mailing Address - Fax:
Practice Address - Street 1:32541 BERTRAM DR
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-1520
Practice Address - Country:US
Practice Address - Phone:734-716-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty