Basic Information
| Provider Information | |||||||||
| NPI: | 1801819149 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC CHARITIES OF SHIAWASSEE AND GENESEE COUNTIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 CHIPPEWA ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485031570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102329950 | ||||||||
| FaxNumber: | 8102329110 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 CHIPPEWA ST | ||||||||
| Address2: | |||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485031570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8102329950 | ||||||||
| FaxNumber: | 8102329110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 11/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMACK | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | JEAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8102329950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 250095 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.