Provider Demographics
NPI:1528299658
Name:NOVAK, NICOLE MARIE (LMSW, CAADC)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:NOVAK
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:KOTCHKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1345 MONROE AVE NW STE 323
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4674
Mailing Address - Country:US
Mailing Address - Phone:616-648-4407
Mailing Address - Fax:
Practice Address - Street 1:1345 MONROE AVE NW STE 323
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4674
Practice Address - Country:US
Practice Address - Phone:616-648-4407
Practice Address - Fax:616-608-4657
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801091604104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker