Basic Information
| Provider Information | |||||||||
| NPI: | 1225357130 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCINAK | ||||||||
| FirstName: | MONICA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MA, LMSW, CAAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1654 W LORAIN ST APT 104 | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481623427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343848984 | ||||||||
| FaxNumber: | 7342430145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 S RAISINVILLE RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481619754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7343848949 | ||||||||
| FaxNumber: | 7342430145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2010 | ||||||||
| LastUpdateDate: | 05/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 201346 | MI | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 6801060770 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.