Basic Information
| Provider Information | |||||||||
| NPI: | 1437278249 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DELTA-WAVERLY PSYCHOLOGY AND COUNSELING ASSOCIATES, PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 S CREYTS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489178234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 S CREYTS RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489178234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173234099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WHITING | ||||||||
| AuthorizedOfficialFirstName: | GLENDA | ||||||||
| AuthorizedOfficialMiddleName: | LOU | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5173234099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 1041C0700X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.