Provider Demographics
NPI:1144561291
Name:COLE-MICKENS, HELEN MICHELLE (LLBSW, CADC-M)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:MICHELLE
Last Name:COLE-MICKENS
Suffix:
Gender:F
Credentials:LLBSW, CADC-M
Other - Prefix:MRS
Other - First Name:SHELLIE
Other - Middle Name:
Other - Last Name:COLE-MICKENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LLBSW, CADC-M
Mailing Address - Street 1:1939 DIVISION AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-2459
Mailing Address - Country:US
Mailing Address - Phone:616-247-3815
Mailing Address - Fax:616-245-0450
Practice Address - Street 1:1939 DIVISION AVE S
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-2459
Practice Address - Country:US
Practice Address - Phone:616-247-3815
Practice Address - Fax:616-245-0450
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802085835104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker