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Organization
MAVERICK SPIRITS LLC
Active
Organization
MAVERICK SPIRITS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KANDISS VANCOPPENOLLE M.A. (OWNER)
(517) 442-0207
Entity
Organization
Contact information
Practice address
3100 S WINTER ST APT G11, ADRIAN, MI 49221-8785
(517) 442-0207
Mailing address
3100 S WINTER ST APT G11, ADRIAN, MI 49221-8785
(517) 442-0207
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
05/27/2024
Last updated
05/27/2024
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