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Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LLMSW

Contact information

Practice address
6051 FRANKFORT HWY, #200, BENZONIA, MI 49616
(231) 882-2137
Mailing address
6051 FRANKFORT HWY, #200, BENZONIA, MI 49616
(231) 882-2137

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6801098894
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6801098894
STATE OF MICHIGAN
MI
Enumeration date
12/18/2015
Last updated
12/18/2015
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