| Kintsugi Wellness Counseling Pllc | |
|
1151 Michigan Ave Ste 108 East Lansing MI 48823-4078 | |
| (517) 819-2527 | |
| Not Available |
| Full Name | Kintsugi Wellness Counseling Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 1151 Michigan Ave Ste 108, East Lansing, Michigan |
| Authorized Official Name and Position | Carol Lynn Dixon (MEMBER/OWNER) |
| Authorized Official Contact | 5178192527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintsugi Wellness Counseling Pllc 3629 Lucie St Lansing MI 48911-2800 Ph: (517) 819-2527 | Kintsugi Wellness Counseling Pllc 1151 Michigan Ave Ste 108 East Lansing MI 48823-4078 Ph: (517) 819-2527 |
| NPI Number | 1952927923 |
|---|---|
| Provider Enumeration Date | 06/24/2020 |
| Last Update Date | 06/24/2020 |
| Certification Date | 06/24/2020 |
| Medicare PECOS PAC ID | 4789096512 |
|---|---|
| Medicare Enrollment ID | O20201218001071 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952927923 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Carol L Dixon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144286600 PECOS PAC ID: 8022261767 Enrollment ID: I20180202001652 |
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