Provider Demographics
NPI:1194433524
Name:DORRELL, NICOLE DENISE (LMSW CTP-C CSTIP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DENISE
Last Name:DORRELL
Suffix:
Gender:F
Credentials:LMSW CTP-C CSTIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E OAKLEY PARK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48390-4315
Mailing Address - Country:US
Mailing Address - Phone:734-559-3540
Mailing Address - Fax:
Practice Address - Street 1:2000 E OAKLEY PARK RD STE 201
Practice Address - Street 2:
Practice Address - City:COMMERCE TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48390-4315
Practice Address - Country:US
Practice Address - Phone:734-559-3540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010986401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical