Basic Information
| Provider Information | |||||||||
| NPI: | 1851420848 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCARTHY | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7012 CAMELBACK DR NE | ||||||||
| Address2: | |||||||||
| City: | ROCKFORD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493419684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6168740219 | ||||||||
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| Practice Location | |||||||||
| Address1: | 516 CHERRY ST SE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164566135 | ||||||||
| FaxNumber: | 6167719761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 07/25/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 60925 | MI | X | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 6401007633 | MI | X | Behavioral Health & Social Service Providers | Counselor | Professional | 101YA0400X | MI | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.