Provider Demographics
NPI:1053784348
Name:POLAN, NICOLE CHRISTINE (LMSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:CHRISTINE
Last Name:POLAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 PLYMOUTH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9558
Mailing Address - Country:US
Mailing Address - Phone:734-335-4747
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD STE 110
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9558
Practice Address - Country:US
Practice Address - Phone:734-335-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802088716104100000X
MI68011160721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker