Provider Demographics
NPI:1710229174
Name:GLADE, NICOLE (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GLADE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 N MILFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1047
Mailing Address - Country:US
Mailing Address - Phone:248-684-6400
Mailing Address - Fax:248-322-0006
Practice Address - Street 1:1800 N MILFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:248-684-6400
Practice Address - Fax:248-322-0006
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011225101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional