Basic Information
| Provider Information | |||||||||
| NPI: | 1659408086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCREARY | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1939 DIVISION AVE S | ||||||||
| Address2: | FAMILY OUTREACH CENTER | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495072459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Practice Location | |||||||||
| Address1: | 1939 DIVISION AVE S | ||||||||
| Address2: | FAMILY OUTREACH CENTER | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495072459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6162473815 | ||||||||
| FaxNumber: | 6162450450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 10/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.