| Doctor Name: | NICOLE CARLSON |
| NPI Number: | 1568828408 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6401010393 |
| Business Practice Address: | 1246 Yorkshire Rd Grosse Pointe Park, MI - 482301106 |
| Business Phone Number: | 3138854611 |
| Business Fax Number: | |
| Mailing Address: | 1246 Yorkshire Rd, GROSSE POINTE PARK |
| State: | MI |
| Postal Code: | 482301106 |
| Phone Number: | 3138854611 |
| Fax Number: | |
| NPI Enumeration Date: | 01/07/2016 |
| NPI Last Update Date: | 01/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401010393 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |