| Maverick Spirits Llc | |
|
3100 S Winter St Apt G11 Adrian MI 49221-8785 | |
| (517) 442-0207 | |
| Not Available |
| Full Name | Maverick Spirits Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3100 S Winter St Apt G11, Adrian, Michigan |
| Authorized Official Name and Position | Kandiss Vancoppenolle (OWNER) |
| Authorized Official Contact | 5174420207 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maverick Spirits Llc 3100 S Winter St Apt G11 Adrian MI 49221-8785 Ph: (517) 442-0207 | Maverick Spirits Llc 3100 S Winter St Apt G11 Adrian MI 49221-8785 Ph: (517) 442-0207 |
| NPI Number | 1699515999 |
|---|---|
| Provider Enumeration Date | 05/27/2024 |
| Last Update Date | 05/27/2024 |
| Certification Date | 05/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699515999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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