Provider Demographics
NPI:1669560132
Name:NOELKE, WILLIAM HENRY (MA, LPC, LMSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:HENRY
Last Name:NOELKE
Suffix:
Gender:M
Credentials:MA, LPC, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 S LAKESHORE RD
Mailing Address - Street 2:RR # 1
Mailing Address - City:PORT SANILAC
Mailing Address - State:MI
Mailing Address - Zip Code:48469-9632
Mailing Address - Country:US
Mailing Address - Phone:810-622-8918
Mailing Address - Fax:
Practice Address - Street 1:595 S LAKESHORE RD
Practice Address - Street 2:RR # 1
Practice Address - City:PORT SANILAC
Practice Address - State:MI
Practice Address - Zip Code:48469-9632
Practice Address - Country:US
Practice Address - Phone:810-622-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002946101YP2500X
MI6801014116104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker