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Individual
MR. MICHAEL ALLEN IDE
Active
Individual
MR. MICHAEL ALLEN IDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
NULL
104100000X
Social Worker
Primary
SW129791
PA
Other
Enumeration date
05/29/2008
Last updated
08/17/2017
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