Individual
BETHANY EISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 STODDARD RD, RICHMOND, MI 48062-2505
(810) 392-2167
Mailing address
1450 RIVER RD, UNIT 17, SAINT CLAIR, MI 48079-2809
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
E250085603037
MI
Other
Enumeration date
11/04/2013
Last updated
11/04/2013
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