| Making A Difference Support Services, Llc | |
|
1867 Airport Way Ste 200 Fairbanks AK 99701-4061 | |
| (907) 750-7169 | |
| (907) 490-4469 |
| Full Name | Making A Difference Support Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 1867 Airport Way Ste 200, Fairbanks, Alaska |
| Authorized Official Name and Position | Crystal Devon Mccormick (OWNER) |
| Authorized Official Contact | 9077507169 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Making A Difference Support Services, Llc 1867 Airport Way Ste 200 Fairbanks AK 99701-4061 Ph: (907) 750-7169 | Making A Difference Support Services, Llc 1867 Airport Way Ste 200 Fairbanks AK 99701-4061 Ph: (907) 750-7169 |
| NPI Number | 1013424225 |
|---|---|
| Provider Enumeration Date | 01/09/2018 |
| Last Update Date | 04/04/2018 |
| Medicare PECOS PAC ID | 8325302979 |
|---|---|
| Medicare Enrollment ID | O20180507000901 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013424225 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | CSWS1053 (Alaska) | Primary |
| Provider Name | Crystal D Mccormick |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1790029114 PECOS PAC ID: 2062657802 Enrollment ID: I20130326000412 |
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