Organization
FRESH AIRE SAMARITAN COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA M MCILVENNA DMIN (EXECUTIVE DIRECTOR)
(989) 835-7511
Entity
Organization
Contact information
Practice address
315 W LARKIN ST, MIDLAND, MI 48640-5152
(989) 835-7511
Mailing address
315 W LARKIN ST, MIDLAND, MI 48640-5152
(989) 835-7511
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
6401010105
MI
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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