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Organization
LITTLE HOUSE ON MACKINAW, LLC
Active
Organization
LITTLE HOUSE ON MACKINAW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANE KUKULIS LMSW (SOLE MEMBER)
(989) 790-2005
Entity
Organization
Contact information
Practice address
6988 MACKINAW RD, BAY CITY, MI 48706-9332
(989) 790-2005
(989) 790-2002
Mailing address
6988 MACKINAW RD, BAY CITY, MI 48706-9332
(989) 790-2005
(989) 790-2002
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/13/2021
Last updated
10/13/2021
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