Provider Demographics
NPI:1447904289
Name:NICOLE SOBH THERAPY LLC
Entity type:Organization
Organization Name:NICOLE SOBH THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:313-969-3705
Mailing Address - Street 1:330 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1316
Mailing Address - Country:US
Mailing Address - Phone:734-655-0051
Mailing Address - Fax:
Practice Address - Street 1:330 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1316
Practice Address - Country:US
Practice Address - Phone:313-969-3705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-10
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty