Provider Demographics
NPI:1538670807
Name:ANDERSON, NICOLE EVE (PSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:EVE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6557 LINVILLE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9531
Mailing Address - Country:US
Mailing Address - Phone:248-860-2531
Mailing Address - Fax:
Practice Address - Street 1:2200 GENOA BUSINESS PARK DR STE 100
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-5328
Practice Address - Country:US
Practice Address - Phone:810-494-7180
Practice Address - Fax:248-692-4936
Is Sole Proprietor?:No
Enumeration Date:2017-10-13
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017273103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist