Organization
MAKING A DIFFERENCE SUPPORT SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL DEVON MCCORMICK (OWNER)
(907) 750-7169
Entity
Organization
Contact information
Practice address
1867 AIRPORT WAY STE 200, FAIRBANKS, AK 99701-4061
(907) 750-7169
(907) 490-4469
Mailing address
1867 AIRPORT WAY STE 200, FAIRBANKS, AK 99701-4061
(907) 750-7169
(907) 490-4469
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSWS1053
AK
Other
Enumeration date
01/09/2018
Last updated
04/04/2018
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