Individual
MICHAEL HANDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-9824
(907) 486-3498
Mailing address
3449 E REZANOF DR, KODIAK, AK 99615-6952
(907) 486-9824
(907) 486-3498
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
TTS02-09-006P
AK
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDC 1 3614
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DA4442
—
AK
Enumeration date
05/03/2007
Last updated
01/19/2010
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