Individual
MS. ELLEN LORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN,MA,CAC-R,CCM
Contact information
Practice address
1005 MAY ST STE A, CHARLEVOIX, MI 49720-9380
(231) 883-7738
(231) 588-7030
Mailing address
PO BOX 61, 1005 MAY STREET, SUITE A, CHARLEVOIX, MI 49720-0061
(231) 883-7738
(231) 588-7030
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
200695
MI
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
4704083965
MI
163WC0400X
Case Management Registered Nurse
Primary
4704083965
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00131110
CERTIFIED CASE MANAGER
MI
01
—
2-00695
CERTIFIED ADDICTION COUNS
MI
01
—
4704083965
REGISTERED NURSE
MI
Enumeration date
05/18/2007
Last updated
11/09/2009
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