Provider Demographics
NPI:1023266301
Name:DOCK, NANCY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:DOCK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 MARYLAND AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2106
Mailing Address - Country:US
Mailing Address - Phone:616-334-9334
Mailing Address - Fax:
Practice Address - Street 1:549 MARYLAND AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2106
Practice Address - Country:US
Practice Address - Phone:616-334-9334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010863511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical