Provider Demographics
NPI:1568289346
Name:STEPHENS, NICOLE (LLMSW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:333 MAYNARD ST STE 402
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2282
Mailing Address - Country:US
Mailing Address - Phone:269-998-1005
Mailing Address - Fax:
Practice Address - Street 1:333 MAYNARD ST STE 402
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2282
Practice Address - Country:US
Practice Address - Phone:269-998-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-24
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511175811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical