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Individual
MARY COLLINS FAIRGRIEVE
Active
Individual
MARY COLLINS FAIRGRIEVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LMSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801019296
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037172
VALUE OPTIONS
MI
01
—
0899098
BLUE CROSS BLUE SHIELD MI
MI
01
—
138355
MAGELLAN BEHAVIORAL HEALTH
MI
01
—
6221012
UNITED BEHAVIORAL HEALTH
—
01
—
MI2530
MEDICARE PTAN
—
Enumeration date
06/17/2005
Last updated
11/28/2016
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