Organization
A NEW HOPE COUNSELING CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD D FANDRICK PH.D. (TRUSTEE)
(517) 323-4531
Entity
Organization
Contact information
Practice address
3815 W ST JOE ST STE A400, LANSING, MI 48917-5600
(517) 323-4531
(517) 323-4531
Mailing address
3815 W ST JOE ST STE A400, LANSING, MI 48917-5600
(517) 323-4531
(517) 323-4531
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
630-100-8822
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
262-068-000
MAGELLAN
MI
01
—
68-0-C34663-0
COMMUNITY BLUE
—
01
—
OC-34663
BC/BS
MI
01
—
P26624F
BLUE CARE NETWORK
MI
Enumeration date
05/02/2011
Last updated
12/12/2017
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