| Making A Difference Support Services | |
|
1867 Airport Way Suite 200 Fairbanks AK 99701-4054 | |
| (907) 750-7169 | |
| (907) 490-4469 |
| Full Name | Making A Difference Support Services |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1867 Airport Way, Fairbanks, Alaska |
| Authorized Official Name and Position | Crystal Mccormick (OWNER) |
| Authorized Official Contact | 9077507169 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Making A Difference Support Services 1302 Benshoof Dr North Pole AK 99705-5666 Ph: (907) 590-2100 | Making A Difference Support Services 1867 Airport Way Suite 200 Fairbanks AK 99701-4054 Ph: (907) 750-7169 |
| NPI Number | 1558715391 |
|---|---|
| Provider Enumeration Date | 04/18/2016 |
| Last Update Date | 04/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558715391 | NPI | - | NPPES |
| 1634221 | Medicaid | AK | |
| K164905 | Other | AK | MEDICARE PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 1053 (Alaska) | Primary |
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