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Individual
NICOLE M. PETTIBONE
Active
Individual
NICOLE M. PETTIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
6801097713
MI
1041C0700X
Clinical Social Worker
6801097713
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6801097713
STATE OF MICHIGAN - MICHIGAN DEPARTMENT OF LICENSING & REGULATORY AFFAIRS
MI
Enumeration date
04/15/2015
Last updated
01/20/2020
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