Basic Information
| Provider Information | |||||||||
| NPI: | 1760904585 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOLSCHON | ||||||||
| FirstName: | DEVIN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9844 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | IRA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480232813 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9844 DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | IRA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480232813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867167600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2017 | ||||||||
| LastUpdateDate: | 07/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6401016201 | MI | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.