Provider Demographics
NPI:1124888714
Name:MORINE, NICOLE RYLIE (MS, LPC, NCC, CYMHS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RYLIE
Last Name:MORINE
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CYMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31600 TELEGRAPH RD STE 230
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4372
Mailing Address - Country:US
Mailing Address - Phone:248-723-9200
Mailing Address - Fax:248-723-9218
Practice Address - Street 1:31600 TELEGRAPH RD STE 230
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4372
Practice Address - Country:US
Practice Address - Phone:248-723-9200
Practice Address - Fax:248-723-9218
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018570101YM0800X, 101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional