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Organization

IMPACT

Active
Other names
CHR
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT E. GAMBLE PH.D (CLINICAL DIRECTOR)
(810) 985-5168
Entity
Organization

Contact information

Practice address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5168
(800) 248-1568
Mailing address
1001 MILITARY ST, PORT HURON, MI 48060-5416
(810) 985-5168
(800) 248-1568

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6801093360
MI

Other

Enumeration date
10/06/2011
Last updated
10/06/2011
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